Letters: What on earth is going on with the management of Calmac, CMAL and Transport Scotland?



I READ the article by Martin Williams (“Islanders hit out at ferry switches as port shuts for ‘rope’ repairs”, The Herald, September 19) with growing concern regarding the competency of the management of the organisations that are involved in delivering Calmac services.

I found it incredible that the condition of the link span hoist ropes at Lochboisdale had deteriorated to a dangerous condition in the space of 12 months from the previous annual inspection. During my engineering career in the coal and railway industries I was involved in wire rope maintenance, inspection and renewal. Whilst the affected ropes at Lochboisdale operate in a harsh marine environment I would have expected that deterioration on individual wires and groups of wires would have been detected during PPM (Planned Preventative Maintenance) examinations of the link span. The law requires a Duty Holder to have schemes of maintenance in place and being implemented. Therefore what maintenance does CMAL (Caledonian Maritime Assets Limited) actually carry out between the annual inspections? Also for consideration are the assurance arrangements that Calmac should have in place to make sure that the port and terminal facilities that CMAL is responsible for are safe and compliant. Are similar linkspans in the CMAL and local authority asset registers being subjected to additional inspections?

My other concern is the adverse impact on the residents and visitors to South Uist, Benbecula and North Uist, and the local economy which relies heavily on the Calmac services at Lochboisdale and Lochmaddy. Transport Scotland appears to wring its hands and lay blame on either or both CalMac and CMAL. It is the funding provider on behalf of the Scottish taxpayers and needs to step up to the mark and take positive action, not impose fines as has been done recently. The Transport Minister at Holyrood also needs to take action to resolve the wider issues that currently surround Calmac and CMAL. It is not acceptable to keep talking about the delayed Glen Sannox and the still-to-be-launched Hull 802 as “coming soon”; additional second-hand tonnage is required now.

If service reliability is not improved soon, then the economy of the Western Isles and Arran will decline with job losses and potentially depopulation.

I can only hope that things improve soon.

Kevin A McCallum, Glasgow.

STATE CONTROL OF OUR HEALTH

I HAVE now received my appointment for a Coronavirus booster vaccination. I understand there is no choice as to which vaccine will be given, and specifically that AstraZeneca will not be on offer.

I believe that the booster vaccines are targeted for the original and Omicron variants of Coronavirus. To my mind, this is illogical if the aim is to protect against the next variant. For this reason, I would prefer to receive the original AstraZeneca product.

I have no medical qualification (but I am a lawyer). It seems to me that any medical treatment or intervention requires informed consent by the patient. I am therefore disturbed that the state appears to be imposing its will with no regard to the views of the citizen. I am writing to my MSP. Do any other readers share my concerns about this affront to the rights of the individual?

Scott Simpson, Glasgow.

LET’S SALUTE FENWICK’S FINEST

RECENT articles and correspondence on the subject of Kelvingrove museum’s treasures (“Sell Glasgow’s very own Dali? Not on your life!”, The Herald, September 16, and Letters, September 17 & 19) gave me reason to ponder on the life of John Fulton, born in 1803 the son of a shoemaker in the Ayrshire village of Fenwick.

Many people bandy the word “genius” around willy-nilly these days, but there can be no doubt that the epithet fits Fenwick’s finest perfectly.

John Fulton left the local school at 13 and, to be kind, did not present any real indication of his brilliance – in fact, the school master at the time, a Mr Fairley, decided not to charge Fulton’s father for his arithmetic lessons, saying “that there had been little done in that way.” However, inspired by another great Scot, James Ferguson (himself an autodidact who had little formal education), Fulton set out to educate himself and became “a most successful inventor and practical machinist”.

As well as becoming a knowledgeable botanist and an expert gardener, Fulton carved sundials from stone, and he experimented with the utilisation of coal gas which he used to heat the family home, Spoutmouth. In addition, he built a bicycle for a local lad who could not get about as well as his friends due to a disability.

Fulton’s magnanimity and ingenuity did not stop there. A local lass who had one leg shorter than the other and who could not get around without a crutch was the recipient of a leg brace engineered by Fulton which allowed her to throw away the crutch and get around as ably as her friends.

These were only recreational pursuits, though, and after teaching himself mathematical calculations, he created his own crude versions of Ferguson’s lunarium, a machine which shows the motions and the phases of the moon. Buoyed by this success, Fulton set to work on building his orrery, a clockwork model of the solar system and its movements including the rotations of the planets and their moons.

Of the three orreries Fulton is known to have created, the one which is on display in Kelvingrove is widely considered as being one of the finest ever, consisting, as it does, of 15 concentric shafts, 175 wheels and cogs, and more than 200 moving parts. Some of the parts are so small (1/54th of an inch) that Fulton had to make the tools to fashion these components himself.

John Fulton was rightly lauded across Great Britain and the boy who had left school able only to read and write rose to work as an instrument maker to King William IV, assigned to work with a Mr Bates in London.

After an illness which necessitated treatment at St Bartholomew’s Hospital, Fulton returned to Fenwick in 1851 and this is where he died in 1853. His grave can be found in the local kirkyard, and the local public meetings hall bears his name.

If any readers have not taken a trip to Kelvingrove to see Fulton’s Orrery, then I urge them to do so.

Gordon Fisher, Stewarton.

SO SHOULD ECONOMISTS COUNT?

MY enthusiastic support for Alexander McKay’s views on the SNP’s top economic guru,Tim Rideout (Letters, September 19), was tempered by a quotation attributed to George Bernard Shaw: “If all the economists were laid end to end, they would not reach a conclusion.”

Unfortunately, interpreting economic data is both an art and a science.

David Miller, Milngavie.





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‘DIY dentistry’ fears as one in four Scots unable to get NHS appointment



ONE in four dental people in Scotland say they have tried and failed to get an NHS dental appointment in the past year, with some resorting to “DIY dentistry” in desperation.

The survey of more than 2,200 adults across the UK, including nearly 200 in Scotland, was carried out in August by Savanta Comres on behalf of the LibDems.

Across the UK as a whole, they found that 23 per cent of people had tried unsuccessfully to get an NHS dental appointment in the past 12 months. Among respondents in Scotland, the figure was 25%.

Of those across the UK unable to get an NHS appointment, 21% said they had “carried out dental work” themselves or “asked somebody else who is not a dentist to do so”.

In Scotland, the figure was lower at 15% of respondents. Three in 20 said they had opted to pay for private treatment instead, with the same percentage saying they had either “travelled a long distance” to see an NHS dentist or given up on seeing a dentist “despite suffering with pain”.

READ MORE: Dentists say they cannot afford to provide NHS treatment 

Access to NHS dentistry has become increasingly difficult, with research in August revealing that nine in 10 UK dental practices were refusing to take on any new patients on an NHS basis.

In Scotland, the figure averaged four in five, although in some areas – including Dumfries and Galloway and Dundee – no dental practices were accepting new NHS patients.

Most dental practices are mixed, providing both NHS and private treatment, but it has become increasingly common for patients to be told they can only be registered as a private patient.

Dentists say the spiralling costs of running practices – including staff salaries and overheads such as heating and lighting – make it increasingly unaffordable to provide NHS treatment at current rates.

Health is devolved, but total amount available to spend on public services is influenced by decisions taken at a UK level.

Liberal Democrat Health Spokesperson, Daisy Cooper MP, said: “It is now or never to save our NHS from a winter of crisis that will put patients at risk. This heartbreaking rise in DIY dentistry is further evidence that this Government simply doesn’t care about our vital local health services.

“It is a national scandal that people are forced to pull their own teeth out because our public health services have been starved of funding.”

It comes after the latest statistics for Scotland showed a sharp dip in the number of dental treatments being carried out on the NHS.

According to Public Health Scotland figures, dentists were being reimbursed for an average of 330,000 NHS treatment claims per month between April, May and June this year.

READ MORE: Tooth extractions up 26 per cent compared to pre-pandemic levels

This followed the easing of Covid infection control protocols from April 1, increasing the number of patients who could be seen, along with the introduction of a temporary multiplier by the Scottish Government which reimbursed dentists £1.70 for every £1 of NHS treatment claimed.

This was cut to £1.30 from July onwards, however, with figures showing a 21% slump in the number of claims paid, to 261,537, that same month. Sharp decreases were seen for everything from basic examinations to root canals, fillings, extractions and X-rays.

Dental leaders say the 1.3 rate is too low to cover costs, deterring NHS work, and want to see a major overhaul in the payment system applied to NHS dentistry.

The current multiplier arrangement is due to expire at the end of September, and it remains unclear what will replace it.

Public Health Minister Maree Todd said: “Reimbursement claims are over 40% higher for the three months to the end of July compared with the three months to the end of March, demonstrating strong recovery of the sector and a commensurate level of patient throughput.

“I am grateful for the hard work of dental teams across the country who have worked hard to see more patients as infection prevention and control measures were reduced and we are continuing to provide NHS dental services with an unprecedented level of financial support.”





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Rosemary Goring: 143 different drugs to tackle dementia are undergoing trials – are we on verge of a breakthrough?



THE holy grail of medicine in the 20th century was to find a cure for cancer. Given there are more than 200 types, this was an awesome task, dominating the lives of an army of scientists, each of whom chipped away at the marble rockface of this much feared disease. You won’t find a better description of what this entailed than Siddhartha Mukherjee’s The Emperor of All Maladies, an enthralling account of the race to find answers.

As with any prolonged battle, it was (and continues to be) a story of advances and reversals, sometimes achieved in the face of daunting obstacles. Many decades on, despite the resources poured into the fight, cancer has not yet been vanquished. It is still a diagnosis everyone dreads. It still claims far too many lives. But since with some cancers it is possible to have treatment that is effectively curative – that slows its progress sufficiently that you’re more likely to die of something else – the situation is light years away from what it was in the 1950s.

Meanwhile, the search continues for ways of combatting even the most intractable forms of the disease. Such have been the advances, it is now conceivable that eventually every form of cancer, if caught in time, will be treatable, to the extent that sufferers can live with it for the rest of their lives.

Today, no medical breakthrough catches headlines like the prospect of a cure for Alzheimer’s, which has become this century’s greatest medical challenge for those in the West. In the past 20 years we’ve read countless articles about pharmaceutical companies trialling drugs which – they all hope – will take the sting out of dementia. In the end, however, the outcomes have always been a disappointment. In scientific circles, the old joke is that for the past 30 years, they’ve “always been five years away” from a life-changing treatment.

At the moment, the results of three promising stage three trials by different firms – Roche, Eisai and Biogen, and Eli Lilly and Company – are expected imminently. (Stage three is the final hurdle before seeking approval for drugs to go on the market.) Although each takes a different approach, all of them are targeting the build up of a toxic protein called amyloid, widely considered to be the root of the brain degeneration caused by Alzheimer’s.

On one side of the medical fraternity are the optimists, who think these drugs might represent the eureka moment we’ve all been waiting for. They believe that, although they won’t eradicate dementia, if taken after an early diagnosis they could offer an additional three years of good quality of life. And that’s just the start. Once these medicinal building blocks have been confirmed as efficacious, they can be adjusted to suit a variety of needs. In this scenario, many of us might one day find ourselves taking a cocktail of medicines at sundown as easily, and regularly, as a G&T.

Pessimists, however, are less convinced by the powers of these supposedly super-drugs. Some, indeed, think that the focus on amyloid as the cause of Alzheimer’s is misguided. Robert Howard, Professor of Old Age Psychiatry at University College London, is one of the sceptics. “There is a clear indication that somehow amyloid is involved in Alzheimer’s,” he says, “but it’s not clear that the presence of amyloid in your brain drives the disease. It might be like a tombstone that happens at the end, where the amyloid is actually a protective protein that the brain produces to try and protect itself. We don’t know. But removing amyloid doesn’t seem to make any difference to the course of Alzheimer’s disease.”

Imagine having worked for years on the assumption that getting rid of amyloid is key, only to learn that you have been following the wrong trail. You might think that is a definition of tragedy, of spectacularly wasted effort and energy. On discovering this, how could someone find the motivation to get out of bed and head back to the laboratory?

Yet you’d be wrong. Even if eliminating amyloid is not the solution, and even if the latest drugs fall short, this is simply the nature of medical research. Samuel Beckett’s exhortation, “Ever tried. Ever failed. No matter. Try again. Fail Again. Fail better.”, should be pinned to every lab door.

The speed with which effective vaccines for Covid were formulated has perhaps blinded us to the reality of how treatments are generally found. The hunt for a cure is as much about elimination as hitting the bull’s eye. Of course there are occasional happy accidents or blinding revelations, but miracles in medicine are almost as rare as unicorns. The laborious task of following one line of enquiry until obliged to reject it and find another, is how the process works. Every triumph is built on the work of unheralded legions of pharmacologists and medics, racing to explore every possible avenue of inquiry. Even though the vast majority of them will never win the Nobel Prize, their endeavours, and their errors, are essential to the success of those who do.

A case in point is malaria, which for a century has eluded the finest brains in medicine. Last year, a vaccine was finally approved for use in children, and this year Oxford University has been trialling a vaccine thought to offer up to 80% protection, at an affordable price. Since around 409,000 people a year die from malaria worldwide, this is a game-changer in terms of global health. Yet the fact it has taken 100 years to get to this point shows not only how difficult a challenge it has proved, but that despite dedicated teams of scientists, some ailments remain stubbornly resistant to intervention. Those suffering from Motor Neurone Disease – to name but one of several as yet incurable illnesses – are only too well aware of this.

With Alzheimer’s, it looks as if there are good reasons to be hopeful. Currently 143 different drugs are undergoing stage three trials, each of them approaching from a different angle. You could see the disease as being like a bolted door, at which medics have been hammering for decades. They’ve used pick-axes, battering rams, rocket launchers, and still it’s not giving in. But everybody knows it’s only a matter of when. Will it happen in my lifetime? I couldn’t say. In our grandchildren’s? I’d be prepared to bet on that.





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