More Medical Moaning

As I predicted back in January, Covid-19 has once again disrupted my treatment, albeit this time it appears it was the hospital communication processes that were been struck down. In late February I received a letter cancelling the March in-patient appointment, which had already been pushed back from early February. The day I received the cancellation letter I received another one dated the same day scheduling a telephone consultation at the precise date and time of the cancelled in-patient appointment. Presumably the appointment system couldn’t cope with simply sending one letter converting an appointment from in-patient to a telephone consultation?

When consultation day arrived I made sure to clear my work diary around the scheduled time, and sat patiently with both landline and mobile at hand, I didn’t even dare pop to the loo for fear of missing it. I waited and waited, but alas, no phone call ever came, nor were there any missed calls or voicemails.  The next day I called the appointments line and was eventually able to leave a message with the Nephrology department. The day after that I received a call back to inform me that the doctor had attempted to call me, but had been unable to get through. They confirmed both my mobile and landline number were correct on the system, and I know for a fact that both were in working order on the day itself, yet for some reason neither were reachable at the time of the consultation.

Of course, it is possible that by some strange coincidence, both my landline and mobile were disconnected from their respective networks at just as the doctor called, only to be reconnected shortly after. I think it’s more likely that the doctor simply tried a wrong number and then moved on when it didn’t work, which is why there were no missed calls and no messages. Occam’s Razor and all that!

Instead, I got a copy of the letter to my GP advising my condition is stable, that the Alfacalcidol medication should be doubled and that as my platelet count has been chronically low since 2013 it will be referred to Haematology for assessment. A low platelet count does explain a few things, but none of them are particularly worrisome, which I suspect is why it’s taken eight years for it to be picked up. Of slightly more concern is that the target range for blood pressure is lower than what I’m typically achieving on my home readings.     

It will be interesting to see if anything at all comes off the back of this letter, I’m inclined to think not.

Parking Rage

Three years ago, I wrote about problem parking in the area I live, and the general shiteness of the parking enforcement. Fortunately, since then I haven’t had too many serious issues, there’s been plenty of anti-social twats who’ve left their vehicles overhanging the dropped kerb, and a handful of times I’ve had to ask people to move, but until last week I’d never had to get a car towed away.

Reigate & Banstead Council, which previously had the contract for (not) enforcing parking restrictions were replaced by Sevenoaks Council some time back, my contacts tell me they are making a better fist of things (working off a very low baseline). It’s just a shame Tandridge District Council still don’t want to manage it in-house, as I’m pretty sure a properly managed service would pay for itself. But then TDC and properly managed services aren’t the bedfellows they once were, but the reasons for that are too complex to discuss here.

The demand for parking in local streets appeared to slacken during the initial lockdown last year, probably due to less people visiting shops and work places a short walk away, however, it’s picked up slightly during this latest lockdown. It doesn’t help that some of the local motoring businesses use these streets as storage space for unwanted vehicles (and the authorities make little attempt to stop them). But generally speaking, it’s still quieter during evenings and weekends when demand for parking peaks.

It started one afternoon a couple of weeks ago, a small white car parked across the driveway at the rear of my house, completely blocking my car in. Being a weekday afternoon, when many locals are at work, there was no shortage of parking spaces. Yet this clown ignored the no parking sign on the driveway gate, ignored the empty spaces, and parked their car directly over the access protection line. I called the Police non-emergency number, but the Police couldn’t trace the driver and had no units available. The best they could offer was a promise to attend in the morning if I was still blocked in. I also reported it to Sevenoaks Council, but I’d left it too late for daytime enforcement and it appears out of hours cover is still a shortcoming. Fortunately, the twat removed the vehicle a few hours later, but not before I had to rejig personal commitments.

A day or two later the same car was parked a little further up the road, and I spotted the driver getting in and pulling away, it appeared to be woman of Indian heritage. This time she’d had the decency to use one of the many free spaces. But the following week, on a Wednesday morning, the car was back and again blocking my car in. As it was a week day, during the day, there was again plenty of empty spaces, but the twat has once again ignored them all and parked straight across the access protection markings. I was livid, this was clearly someone taking the piss, it was a genuine inconvenience as I had stuff to do, and there was just no fucking need for it.

I call the Police non-emergency number again; I made it clear this was starting to look like deliberate anti-social behaviour. This time the Police agreed to send a unit when one became available. I also called Sevenoaks where the lady I spoke to expressed surprise that someone would actually park over access protection markings (a dog bone as she called it) rather than use an empty space. In the end I didn’t need Sevenoaks, the Police turned up within an hour or so and a tow truck duly removed the car (I don’t think it helped when the Police realised it had no MOT).

One of the officers suggested I should put a larger no parking sign on the gate, which I’ve since done, and get the access protection markings refreshed as they are a bit worn, which I’m looking into. But he accepted there was really no excuse for blocking me in, when even the most cursory glance around showed there was no justification. Which made me wonder if the twat driving the car was fully compos mentis?  

Typically, the people who cause problems are driving commercial vehicles such as tradesman who are inclined to dump their vans wherever they can be arsed. Although, most of the time they will move without a fuss if you ask. One such character lives down the road, a deviant hybrid of Captain Jack Sparrow and a cheap Post Malone impersonator, he stinks of weed and once told me it was okay to overhang my drive because he knows the person who owns the house behind mine. It was a complete non-sequitur, but stoners aren’t noted for coherent thoughts.

I once had an argument with a neighbour who owns a garage opposite. Bizarrely, her justification for blocking my driveway was that she didn’t get to choose who parked outside the front of her house, as if in some strange tangential way this was relevant to the entirely unrelated traffic offence she was committing. I helpfully suggested she could park on her own driveway, in front of her own garage, but apparently this inconvenienced her husband’s easy access to the garage. It was simply easier to block my driveway than her own. I couldn’t fault this logic, even if it was missing the point. Since then, I’ve learned she’s somewhat unhinged, and her behavioural issues cause problems for other neighbours and even her husband; but on the positive side she does now park on her own driveway. 

The little white car was back the next day; and ever since it’s stuck to using empty spaces, albeit it often displays slightly haphazard positioning, as if the driver really struggles with basic parking, particularly on kerb. The Police told me it was registered in neighbouring Croydon, where parking on the kerb is generally banned (a London wide policy); so perhaps the driver picked my driveway precisely because the kerb was dropped making it convenient for someone with poor parking skills? I thought she may work in a nearby shop, which made me feel a little sad the car was impounded, but my wife has seen her since and doesn’t believe this. However, it’s clear the driver is smart enough to avoid the parking restrictions around the nearby shops and offices, which means she’s smart enough not block me in for no reason. 

Medical Moaning

 I thought it was about time I wrote an update on my medical situation, a long overdue follow up to Corona Confusion Redux back in June 2020. To recap: my scheduled May Nephrology Clinic appointment was skipped from the list on the day (it was supposed to be a telephone call, and before that a video call), and I'd been given a new appointment for November. I received a letter from the clinic saying things were okay based on the May tests, without any specific details of what that meant. My GP increased my blood pressure medication after I raised some concerns with him, and I subsequently received a blood test form for the November appointment which was missing half the regular tests. So, there were lot of unanswered questions.

In July my scheduled November appointment was cancelled, to be rescheduled for some indeterminate point in the future. This worried me as it meant over a year would pass without access to a Consultant Neprhologist. I realised I shouldn't moan too much, Covid-19 has put others in a far worse situation in regards management of chronic conditions, but part of the reason I'm in this situation is because a series of warning signs were overlooked during my twenties and thirties. At my last appointment I was told I might get between three and five years before I need a transplant, but any serious illness would radically reduce that timeline. I'm lucky that the programme I've followed over the last ten years has radically slowed the decline in kidney function, but I'm close to a tipping point where one serious bout of illness may be enough to bring on end stage.

Fast forward to October and I had my annual medical review with the GP, it was a few months later than normal, and done as a blood test and telephone consultation with a nurse, but it was better than nothing. Generally speaking, all was fine, or at least what passes for fine in someone with my condition, cholesterol had improved and my weight loss means I've even fallen back out of the pre-diabetic range again. I mentioned my concerns around the kidney appointments, which prompted a call from the GP to reassure me there was no immediate danger and as long as I wasn't being discharged I shouldn't worry. He did suggest that the recent bloods might trigger some activity from the Nephrology clinic, but if I didn't hear anything by the New Year he'd write a letter.

Sure enough in early November I got a call from the Nephrology clinic informing me they'd sent a telephone appointment for the end of the month, but they were going to bring it forward to the 10th as a slot had opened up and I had recent bloods. So, almost a year after my last appointment I got to speak to a consultant. In summary there has been a small dip in my function, nothing major, and within the range of previous fluctuations, but enough to put me back on a three-month appointment cycle. Well, that was the plan, as is the way of the ‘new normal’ that appointment has since been pushed back a month to March, I wouldn’t bet against it being moved back again.

I recognise Covid-19 has turned the world upside down, and I’m really lucky that I’m not end stage right now. On the other hand, I’m acutely aware I have no safety buffer anymore, it’s been made clear to me that one serious bout of illness could be enough to push me into end stage. It’s possible I’ve already had the virus, my daughter tested positive before Christmas, albeit she was largely asymptomatic (a day or two of headaches and a lost of taste/smell). My wife, my son and myself all tested negative, but I did subsequently experience a few days of feeling run down which I wrote off as overwork. I’ve made peace with the fact I will end up on dialysis before this decade is out, but I’m not in any hurry to get to that point.

Healthier You Update

Been a bit too busy for blogging lately, but I did get a positive response from East Surrey Clinical Commissioning Group about my complaint. I received a call from the diabetes prevention programme manager who apologised for the way my referral was handled, he admitted there had been ‘resource issues with the provider’ (although he didn’t name Ingeus by name) and that I wasn’t the only working person who’d had difficulties. Apparently, there is a new provider coming in shortly to provide a more flexible service including an online programme for those who cannot get to appointments during the day. He’s going to put my name forward as one of the first to be referred to this, so I await further news.

Ingeus and Healthier You: a total shower of shit

In my last few posts I’ve mentioned all is not well with my referral to ‘Healthier You’ the not so early intervention diabetes programme. I’ve written before about the shambolic performance from Ingeus, the outsourced provider delivering the programme in my area, but having given it the benefit of the doubt several times I found thing only ever got worse.

A short summary of events: in late 2017 my GP referred me to this programme, he thought it would be helpful given my health issues and weight management difficulties. I didn’t hear anything for several months, I mentioned this to the practice nurse during a routine appointment, she did a little digging and uncovered I’d been rejected. But Ingeus hadn’t bothered to inform me, and nobody at the surgery had picked up on it. So, she helpfully got the referral raised again, a month or so later I got the letter inviting me to join and a few weeks later a phone call to arrange times.

According to the bumf, the programme would be delivered as group sessions around two hours long, starting with four weeks of weekly sessions and then nine months of monthly sessions. Sounded like a clinically charged-up version of Weight Watchers. The first advisor offered me sessions on a Tuesday afternoon, but I had to decline as they were nowhere near work and taking thirteen half days off was a bit of a stretch. But it was okay, they would find me an evening session, after all there will be loads of people like me who work during the day, people who could benefit from early intervention but find appointments during the day a challenge.

About eight months goes by without word, then I get a second call offering me a later afternoon slot, a little bit further away. I decline again, tell the advisor I’m waiting for an evening slot, they tell me they class late afternoon as an evening slot. I tell them it’s still not helpful as I need an actual evening slot, they confirm they can see this from my previous contact. I’m told they’ll have another go at finding me a genuine evening slot and someone will get back to me in a few weeks. 

Two months later a third advisor calls and admits that evening slots don’t exist and they think it’s best if I’m discharged from the programme so my GP can try to find something more appropriate. We have a slightly awkward conversation where he tactfully acknowledges the programme isn’t designed to support people who work during the day, without presenting this as a bit of a fuck up.

A few weeks after that I get a gratuitously inappropriate letter from Ingeus, packed with glib platitudes about how serious diabetes is, and expressing how sorry it is I’ve decided to leave the programme. What the fuck! 

Now, maybe the warning signs were always there, the failure to communicate the initial rejection, the extended wait for the non-existent evening slots being pretty clear indicators. But, perhaps the biggest warning sign was in the promotional bumf, the brochure is plastered with a diverse range of stock photos, but go to the patient case studies on the website and they are overwhelmingly older people, the type who are likely to be retired or semi-retired, not so much in the way of people who work full time and have young families to juggle.

I decided to complain to NHS England, firstly about the piss poor communications which meant it took a year and a half to get to the point where Ingeus, grudgingly, admitted it wasn’t able to support people who work during the day, and secondly about the stupidity of commissioning delivery from a provider unable to support a large chunk of the population for whom an early intervention programme could bring major benefits. Unfortunately, NHS England claims it didn’t commission the programme, which was a surprising given its website says it did (here and here). Maybe the NHS website has been hacked with fake news?

So now I’ve raised the same complaint with East Surrey Clinical Commissioning Group. I sent the letter over a week ago and haven’t heard anything back yet. I don’t have high expectations. I’m betting on a letter with some waffle about budgets being tight, brushing over why a small portion of it couldn’t be put towards people who need evening appointments, especially given the long-term cost saving to the NHS from doing early intervention properly. Or perhaps it’s deliberate, and it was always intended as early intervention for older people, but Ingeus just forgot to mention this when put together communications material?

However, I’ll end on a positive note. I had my annual check-up last week and my blood sugar levels are stable, even if they are still in the pre-diabetes range. I also have an appointment lined up next week with the diabetes lead nurse to discuss possible ways forward.

The not so early intervention programme

Diabetes is back in the news, so seems a good time to finally write that piece about my own experiences with pre-diabetes.

Early summer 2016 my GP warned me a HbA1c test result indicated I was (just) in the prediabetic range. Then in late 2017 he put me forward for a new early intervention programme called 'Healthier You'. A perfectly sensible referral given my medical history, my weight issues, my CKD etc... Unfortunately in mid 2017 another HbA1c test (just) dropped me out of the prediabetes range, the weight issues and the CKD were obviously still there. However, whoever assessed the referral saw the new result and rejected me on an arbitrary line in the sand, more unfortunately they didn't bother to tell me.

In Spring 2018 another HbA1c test result put me back in prediabetic range, everthing else staying the same. I tell the practice nurse 'I'm waiting to be contacted by an early intervention programme', she checks the computer and finds the rejection letter I never got and flags itback to the GP who raises the referal again.

A month or so goes by, making it about six months from the original referral and I'm finally contacted. The advisor offers me a place on a series of clinics running in nearby Caterham, unfortunately these are in the middle of the afternoon, when I'm at work in London. It's an hour and fifteen minutes travel in each direction between the office and the venue, so if I want to attend I need to book an afternoon off work for each appointment. I told the advisor this was no good as I don't work locally, she told me I could go on the waiting list for an evening clinic, that was four or five months ago and I've still to hear anything back.

My own researches suggest that 'Healthier You' is actually the name of two NHS backed diabetes prevention programmes. The programme offered by Surrey and Sussex Healthcare Trust is delivered by a service provider called Igneus, but the version of the programme offered in the location where I work is delivered by ICS Health & Wellbeing, so it's not a case of swapping to a more convenient location.

It's been almost a year since the initial referral, so I am starting to wonder if I will ever get a place, my suspicion is the programme is essentially designed for people who don't work, or who only work part-time, taking multiple afternoons off work isn't really a helpful strategy for people like myself. Commercial 'Fat Fighters' style weight loss clubs tend to offer a variety of convenient time slots and locations to maximise effectiveness, it would be nice to think an NHS diabetes prevention programme would take a lesson from this, but public 'services' are not always known for their focus on the end user.

Hip, hip, hooray for Govia Thameslink Failways

This week started well; for the past two days my morning train has actually gone to where it was supposed to and the afternoon one has only been a few minutes delayed. Last week Govia Thameslink Railway (GTR) only managed to complete the morning train once in four attempts (I worked from home on the Monday so it got a wildcard that day).

Last Tuesday morning I was thrown off at East Croydon when the rostered driver remembered he wasn't trained to stop at the next station (London Bridge) and the service had to be diverted, on Wednesday it was cancelled completely, and on Thursday the driver again wasn't trained to complete the route. On that occasion passengers were told to get on the next service only to be thrown off that too because the next driver wasn't trained to complete the roster either. According to station staff they genuinely don’t know if a driver will be able to complete the trip till it’s on route, and the drivers themselves don’t seem keen to announce their lack of capability till they have no other option. As London Bridge is the most popular station on this route (and my stop) the result is a mass detraining with hundreds desperately scrambling across platforms for the next dangerously overcrowded train.  

Since the botched implementation of the Rail2020 timetable last month GTR ‘services’ have declined from unreliably shite to shambolically unreliably shite. Long-standing failings having been exacerbated by changes it simply wasn't capable of implementing. Absolutely nobody was surprised by the failure, especially not GTR which appear to have ignored all evidence as well as its own track record.

The abysmal performance of GTR and its puppet master the Department of Transport over the past few years has been documented by journalist David Boyle; he’s debunked much of the false narrative seeking to lay the blame on belligerent trade unions and staff sickies. It’s clear the DfT hired GTR as a hatchet man to hollow out the services in the name of cost cutting. The arrangement designed specifically to give the DfT plausible deniability about the disaster this experiment created whilst also creating a moral hazard whereby GTR still get paid whilst running the operation into the ground.

GTR doesn't employ enough drivers to deliver all its scheduled services, it hasn’t since it took over the former franchises it operates (it has a management contract not a franchise). It doesn’t appear to have done much to recruit and train drivers to plug this structural understaffing; that would incur costs and as it gets paid regardless there is no incentive. Instead GTR relies on massive use of overtime to maintain 'normal' service, which means absolutely no resilience in the system. Sustainable operations run at 80% of capacity in normal times, the other 20% being contingency to handle shocks. Organisations that run at close to 100% all the time are not sustainable because no organisation has perfect operating conditions all the time.

Much has been made of Network Rail's delay in signing-off the new magnum opus timetable. There is some truth in this, but it's an excuse stretched too far. The new routes are materially the same as those consulted on two years ago, GTR should have begun training drivers on the changes earlier and adjusted for any small changes after sign-off. But GTR doesn't have enough drivers, so it doesn't want to take them out of service for training and the DfT didn’t want to delay the new timetable even after a clusterfuck became inevitable.

So now we have ‘short notice service alterations’ where services mysteriously vanish only minutes before their scheduled departure time, where drivers get rostered on to routes they’re not able to complete and where you simply cannot trust any information provided through official channels.   

Charles Horton, the CEO of GTR fell on his sword last week, even the DfT's favourite puppet realised the sheer level of shiteness had moved beyond parody. Transport Minister Chris 'Failing' Grayling hangs on by the skin of his teeth, narrowly surviving a vote of no confidence today, the grim conclusion of the disintegrating Conservative Party being that it doesn’t have anyone to replace him. But ‘Failing’ say it’s okay, he’s sure it’s not his fault and just as soon as he works out why the industry he has been in charge of for the last two years has collapsed he’s going to start doing something about it!

Monty Python's Parking Circus

Warning, the following is a long off topic rant about anti-social parking and how dealing with local authorities sometimes feels like living in a surrealist comedy sketch.

The area where my wife and I live suffers from anti-social and illegal parking. Most houses have some off road parking, but most were built before widespread car ownership and don't accommodate modern volumes. It wouldn't be too bad if households had a couple of cars each, but some have small fleets of five or more (more than they can physically drive), and that's without those who prefer not to use their off road parking, or the twats who use this residential area as a storage lot for their commercial businesses.

We have two driveways, one at the front, and one at the rear, both accessed via dropped kerbs. Both have suffered from obstruction by anti-social scum, the one at rear being particularly problematic. In July of last year my wife applied to Surrey Highways for access protection markings (H bar) across this rear dropped kerb in the hope it would deter pondlife, and in December it was installed. Access protection markings are advisory only, so have no legal value, but they 'advise' the existence of a crossover, and crossovers are protected by Section 86 of the Traffic Management Act 2004. Since the markings went in I've been regularly reporting obstructions to the local 'parking enforcement' team, which have been duly ignored until two weeks ago when I was astonished to receive two replies in succession.

Parking enforcement in Tandridge District is shite. Surrey County Council devolve enforcement to the boroughs and districts and some years ago Tandridge District Council (TDC) outsourced its enforcement to neighbouring Reigate & Banstead Borough Council (R&B). R&B runs token enforcement in Tandridge, a skeleton crew working primarily Monday to Friday daytime, cover more than twenty small towns and villages over ninety-five square miles. Report an offence and you'll get an email saying someone might look in 24 hours, apart from Sunday's when they won't bother. There's no worries about offenders being fleeced by over-zealous wardens hunting profits; parking offences aren't just widely ignored, the absence of enforcement means penalty charge revenue is so limited the 'service' makes a loss.

Local councillors are well aware of the problems and the general shiteness of 'enforcement'. I know because I used to be one and I'm still in contact with my former colleagues. Unfortunately, the district and parish councillors who favour meaningful intervention lack required influence, whilst the county councillor who has influence is mildly sympathetic but reluctant to go as far as meaningful intervention. His reticence is partly due to seeing it as low priority versus Surrey County Council's serious financial problems, but it probably doesn't help that local twats have become conditioned to getting away with their parking offences. The robust solution proposed by those committed to meaningful intervention is a residents parking scheme, but Surrey Highways doesn't want the hassle and there will be a contest between residents who want the problems tackled and residents who cause the problems. A half-way solution would to replace R&B with fit for purpose enforcement, using professional processes and staffing, this would pay for itself, but the inconvenience to offenders remains a political consideration. A couple of years ago the county councillor did support a scheme to reduce double yellow lines around the intersections, this would have freed up extra parking spaces, but it was repelled by residents who pointed out this would prevent access for larger vehicles like refuse collections (already a problem) and would make the area into one giant bottleneck.

So, back to the unexpected responses from R&B. Okay, they were so late as to be useless but it was progress surely? To my eye it looks like R&B has upgraded its reporting system, a cynic might note that the TDC contract comes up for renewal soon; but given that R&B has shown little interest in the contract I suspect that it's more down to the local parish council bunging some additional subsidy its way to try and get a little bit of attention. Whatever, it's welcome intervention, but a little pathetic given a fit for purpose enforcement regime wouldn't need a bung, fit for purpose regimes up and down the country make surpluses just by covering the basics.

However, the responses were eye opening, firstly they pointed out the obstructing vehicles had been removed, fairly fucking predictable given it took two or three days to investigate. But there were other dubious remarks. Both responses stated R&B couldn't enforce advisory markings, disingenuous sophistry given nobody was asking for this, the reported offences were crossover/dropped kerb obstructions which are enforceable. Also, one of the responses stated that they were not able to enforce partial obstructions, only complete blocking of the  crossover. This really did piss me off, as having repeatedly read Section 86 of the Traffic Management Act 2004 I know it does not make any such claims. As a former councillor I'm also well practised in spotting the tricks used by statutory authorities to shirk responsibilities.

I wrote back challenging both claims, and I even got a reply on the latter point (it seems the cheap wheeze conflating advisory markings with crossover obstruction wasn't worth defending). It said:

"Section 86 of the Traffic Management Act 2004 as amended does grant local authorities with Civil Enforcement Powers the power to issue a Penalty Charge Notice to vehicles which are parked adjacent to a dropped kerbs inside of a Special Enforcement Area. However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce. In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb. However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce. In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb."

It seems fair enough, until you read it carefully sentence by sentence:

"Section 86 of the Traffic Management Act 2004 as amended does grant local authorities with Civil Enforcement Powers the power to issue a Penalty Charge Notice to vehicles which are parked adjacent to a dropped kerbs inside of a Special Enforcement Area."

Yep, that's true, I've read the relevant section several times.

"However, please be advised that partially obstructing or overhanging a dropped kerb is not an offence which local authorities are able to enforce."

Hmmm... this is not so clever, the Act itself makes no such claims. It's hard to see how it could be, it would have to define what partial obstruction is, opening up a whole new can of worms.

"In order for the vehicle to be issued with a PCN, the vehicle would need to be parked adjacent to the dropped kerb."

This third sentence is consistent with the first one, but it contradicts the second sentence if you're interpreting them all literally. A vehicle overhanging or partially obstructing a dropped kerb is 'adjacent' to that dropped kerb if you understand the term 'adjacent' in its literal sense. Was I going mad? No. I went and checked in several different dictionaries, here's what the online version of the Cambridge Dictionary says:

"adjacent (adjective): very near, next to, or touching"

So a car overhanging a dropped kerb is adjacent to that dropped kerb, it's physically impossible for it not to be adjacent. More expansive definitions of adjacent actually use synonyms such as contiguous and overlapping, which are even clearer on this point.

So what is going on? Is there some figurative or metaphorical reading of the Traffic Management Act 2004 which reconciles the mutually exclusive claims within R&B's response? Is it possible to be physically adjacent but simultaneously not physically adjacent for the purposes of R&B's claims?

If there is a special exemption for vehicles parked physically adjacent to a dropped kerb, but only overhanging or not completely obstructing, what is the objective definition of this? There has to be an objective definition, otherwise it gets too complicated. How does it work if you can get ingress or egress to a motorbike but not a transit van? Is that partial obstruction? Fuck knows! This the problem when logically inconsistent claims are made. Maybe reconciliation can be achieved by some legislation or statutory instrument omitted from the statement? Maybe R&B has been asked to go soft on parking offences, maybe that's why it's shite, and I'm unfairly maligning apparent indifference? But if that's true why not simply make it clear to the public there's no point in even reporting parking offences? The whole fucking thing is batshit.

More BMI Bonkers!

Another bonkers story about NHS health rationing based on BMI junk science. It appears certain NHS Trusts are rejecting joint replacement operations for obese people who have BMI over 35. They are supposed to go away and lose 10% of their body weight to be reconsidered. Having suffered from gout in the past I know that joint pain is a serious hindrance to leading an active and healthy lifestyle, but gout is sporadic rather than permanant, so God knows how those who need joint reaplcements are supposed to get around this problem.

I'm currently BMI 36 and could probably cheat under 35 by starving for a few days ahead of any medical, but at the start of 2016 I was close to 40. Losing 10% of my body weight (c.13kg) took a year to do and it certainly wasn't trivial, it took lifestyle changes including changes in physical activity. That's where the stupidity of this kind of rationing comes in, to get the treatment they need these people need to lead a healthier and more active lifestyle, but without that treatment they will struggle to lead a healthier and more active lifestyle. Plus if my experiences are anything to go by there will be little in the way of practical support to overcome the lack of acute treatment.