24 Sept 2015

GLOBAL NEWS: ROGERS CENTRE BASEBALL PRICES. shows degree of disposable income for playtime

SINGLE  SEAT
$425
$80
$50

If Local team,"Blue Jays" goes to World Series: $1400.

Canada Health Act (CHA) forbids an Ontario MD to charge a dollar above the Provincial tariff. Does not differentiate between rent and taxes for an office in Central Toronto business area and a remote Rural practice.. Only Francophone QUEBEC allows private medicine.after the CHAOULLI CASE. Dr Chaoulli & (70y patient) G.Zeliotis vs Quebec 2005 Supreme Court Canada 35

(WIKI) Jacques Chaoulli is a physician best known for launching a Supreme Court challenge against the ban in Quebec on private health care.[1] He has French and Canadian citizenship.

Chaoulli was born in France in 1952 and earned a medical degree from the Paris Diderot University. In 1978, he moved to Quebec to study medical education and earned a Master's degree from Université Laval in 1982. Chaoulli has practiced medicine in Quebec since 1986 and is now a general practitioner in Montreal.[2]

In 2005, Chaoulli launched a court challenge against the Quebec government with the Supreme Court of Canada, arguing the Canadian implementation of publicly funded health care was not effective at delivering an adequate level of care.[1][3] After losing in two lower courts, he won the Chaoulli v. Quebec (Attorney General), the Supreme Court's decision on the case, causing a change in the Quebec government's policy on wait times and privatization.
In 2006, he called for further privatization to improve wait times.[4]
He currently serves as a special advisor to the Conservative Party of Quebec.



22 Sept 2015

AIR CANADA CENTRE PLATINUM BOX = $120,000 a year.

"Socialist" fiction of Ontario'a  wealthy  waiting  in GP offices for a ten minute OHIP visit..
 (They go to legal-loophole  WELLNESS CLINICS @ $3500 a year,)


21 Sept 2015

Globe and Mail::Couple shot at expensive steakhouse MICHAEL'S ON SIMCOE.10pm Sunday (yesterday)

Two masked persons shot two diners at walk-in MICHAEL'S.100 Simcoe (W.of University;S on Adelaide)

Well-known steakhouse with ANGUS & KOBE beef.

Left-wing pressure on Toronto police to be kind to criminals.

Safest to eat in HOTELS with entrance`away from restaurant. Increasing violent crime in Toronto. .

20 Sept 2015

Toronto docs moving to DUBAI

NO INCOME TAX

No Islamic dress code for women Shoulders & knees covered EXCEPT for bars & beaches.

Alcohol OK in hotels.and at home with alcohol license.

No public "demonstration of affection"

Homosexuality = death

17 Sept 2015

The News Watch: 500 out of 1700 Canadian student nurses fail American nursing exam


tbnewswatch.com

THUNDER BAY -- Local nursing students are failing their licensing exam at an alarming rate.
A new College of Nurses exam has been brought in this year from the United States.
And the high failure rate is forcing the Regional Hospital to restructure how they schedule their nursing staff.
Details on the pass-fail rate of nursing students at Lakehead University and Confederation College are unavailable.
But according to data from the National Council of State Boards of Nursing for the first quarter of 2015, the test has a less than 30 per cent pass rate for nursing students from outside the U.S.
The Regional Hospital's Chief Nurse Executive, Rhonda Crocker Ellacott, says the new exam has caused a lot of their new hires to fail.
The hospital has created a unit care aid role, to help the unsuccessful nurses until they can write the exam again.
The vice-president of the Ontario Nurses Association, Anne Clark, says it's an unfair situation for nursing students who have successfully completed four years of schooling, only to then fail a test based on American nursing standards.
(TBT News)

Comment: Ontario Registered Nurses have much more responsibility (NPs allowed to diagnoses,investigate and prescribe).. Only one "MAGNET" accredited hosp in Canada by American Nurses Evaluation Centre: Toronto Mt Sinai (Jan 15,2015). In USA 7% of hospitals have MAGNET status. USA computerized exam obviously has a higher standard in keeping with an increasing independent role of Community Nurse-GPs..

16 Sept 2015

TORONTO & MONTREAL: ROYAL PHILIPS FALL ALERT SYSTEM


"A simple fall can have devastating consequences for the elderly. If you fall, you can become disoriented, immobilized, or knocked unconscious and unable to call for help. We respond to the need for access to help in the event of a fall with Lifeline with AutoAlert. Lifeline with AutoAlert is the first pendant-style help button that can automatically place a call for help if it detects a fall and you’re unable to push the button yourself."

Automatic Access to Help If a Fall Is Detected

Lifeline with AutoAlert is our most advanced medical alert system. It features the most widely adopted, proven fall-detection technology in the U.S. medical alert market today. AutoAlert detects more than 95% of falls and can automatically place a call for help if it detects a fall.* For individuals with a history, risk, or fear of falling, Lifeline with AutoAlert can be an excellent choice. The Lifeline with AutoAlert Service includes a Communicator, the AutoAlert Personal Help Button, and 24/7 access to our TORONTO & MONTREAL Response Center. Monthly service :Can$ 65.45 (tax incl.)

14 Sept 2015

LACK OF SECURITY IN ONTARIO HOSPITALS.

NO CONTROL OF MATERIAL BROUGHT INTO HOSPITALS. UNLIKE USA, NO CONTROL OF PEOPLE ENTERING WARD AREAS.

ONTARIO LIBERAL GOVERMENT CUTS PAYMENTS TO MDs by 4.45% on OCTOBER 1,2015

OMA President’s Update: Government Imposes Further Cuts


Inbox
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Ontario Medical Association

13:24 (2 hours ago)


to me
OMA
PRESIDENT’S UPDATE
Vol. 20, No.17
September 14, 2015
Government Imposes Further Cuts
The Ontario government has informed the OMA that effective October 1, 2015, it will impose an additional estimated $235 million in cuts to physician services payments in order to offset its deliberate underfunding of health care in this province.

The Ministry’s plan includes:

An additional 1.3% across the board discount for fee-for-service payments (from 3.15% to 4.45%).

   A further 1% discount on all professional billings in excess of $1 million (in addition to the discount above).

   A series of targeted fee-for-service cuts, including fee adjustments in the areas of diagnostic imaging, point of care laboratory testing, echocardiography, diabetes management, intravitreal injection and pre-operative consultation for low-risk surgery.

The government had earlier signaled its intent to impose further cuts to physicians, and the OMA strenuously objected to the government’s plans and approach. The OMA has now received notice from the Ministry that it will move forward on October 1. We have posted the government’s implementation plan in its entirety on our website (https://www.oma.org/Member/Resources/AgreementCentre/).

The OMA Economics, Research and Analytics Department is conducting an impact analysis that we will make available to members as soon as possible. I have spoken directly to the leaders of those Sections most affected by the Ministry’s targeted cuts.

The Wynne government’s determination to fund the health care needs of Ontarians on the backs of our members marks an ongoing pattern of contempt toward the medical profession and public deception.

The OMA is vehemently opposed to these measures, which we consider unfair and unlawful. I will be seeking an urgent meeting with Minister Hoskins to address these matters directly.

The OMA has consistently delivered the message to government that we need innovative solutions to tackle the challenges of an aging, growing population. Failing to do so threatens our ability to offer the high-quality patient care Ontarians rightly expect. The government is ignoring this message, instead telling physicians that we must provide care under the constraints of their imposed hard-cap on physician services funding.

The OMA Board will meet Wednesday and Thursday this week, and we will provide a more comprehensive update and action plan to members shortly thereafter.

Dr. Mike Toth MD(Univ.Western Ont. 1984)  GP AYLMER,ONT. (popn 7,100)
OMA President

12 Sept 2015

RESISTANCE OF ONTARIANS TO PAY FOR MEDICAL SERVICES

COMMENT. Ontarians pay fortunes for Sports and Toys but think it political  heresy to pay for medical .
care.. Many Ontarians have OHIP supplemented by Private insurance paid by various levels of Government and Unions. Large sums of money are spend on FISHING inc ICE FISHING;; GOLF  (many Municipal Courses)  HUNTING (BOW & RIFLE); ICE HOCKEY, good pads cost $3000; POWER BOATING;(incl JET SKIS)  SAILING;  SKIING (inc SNOW BOARDS), and  SNOWMOBILES. Low OHIP fees for MDs subsidize Ontarians' playtime.

Ontario MDs still have no contract.

The "poor" get free Dentistry; Drugs; Eye`exams and specs;Orthotics (insoles & shoes).;&  transportation.

Dr A Franklin
Fellowship for Freedom in Medicine(Canada)

11 Sept 2015

TORONTO OLFACTORY NERVE CLINIC


Toronto's first clinic for olfactory nerve analysis.and olfactory nerve loss rehabilitation.
OHIP-paid consult with ENT Alexander J. OSBORN MD(Baylor  2005) PhD

OHIP does not pay $60 cost-price of testing material. Also $100 cost for rehabilitation.

180 Dundas St West, Ste 2003.(steps to front door) better access on Northern side of building (123 Edward Sr.)

Indoor parking

Logo of postmedjPostgraduate Medical JournalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Postgrad Med J. 2006 Apr; 82(966): 239–241.
PMCID: PMC2579627

Effects of ageing on smell and taste

Abstract

Disorders of taste and smell commonly present diagnostic dilemmas to the medical profession. This may be secondary to the lack of knowledge and understanding of these conditions. There seems to be a low level of interest in the disorders, when compared with disruption of the other senses such as sight and hearing. Nevertheless, impairment of these senses are common and may be life threatening, especially when they involve the elderly patient. The aetiology of the conditions is widespread, and extend beyond the content of this article. This article will relate only to how the ageing process may contribute to sensory dysfunction. It will focus on how the ageing process changes the normal anatomy and physiology of the senses, how this effects the person's quality of life, and the current management of these conditions.
Keywords: aged, olfaction disorders, taste disorders

The effects of ageing on smell

The sense of smell is often taken for granted, that is until it deteriorates. As we get older, our olfactory function declines.1,2 Not only do we lose our sense of smell, we lose our ability to discriminate between smells. It has been reported that more than 75% of people over the age of 80 years have evidence of major olfactory impairment, and that olfaction declines considerably after the seventh decade.1 A more recent study found that 62.5% of 80 to 97 year olds had an olfactory impairment.3 However, it is widely accepted that taste disorders are far less prevalent than olfactory losses with age.4
There are numerous theories on why the sense of smell deteriorates as we age, I shall attempt to outline a few of these. Various anatomical and physiological theories have been presented. We are aware that both the number of fibres in the olfactory bulb, along with olfactory receptors decrease noticeably with age.1 The bulb losses may well be secondary to sensory cell loss in the olfactory mucosa, along with a general deterioration in central nervous system cognitive processing functions. Even in the absence of disease, olfactory receptor neurones undergo apoptosis at a baseline rate in each person. Mammals have the ability to replace these cells, however this process degenerates with ageing.5 This results in a reduction in the surface area of olfactory epithelium, along with reduced numbers of olfactory receptor neurones. In addition, it is thought that age related olfactory dysfunction is related to an increase in receptor cell death.2 Activation of the piriform/amygdalar region and the orbitofrontal cortex has been shown to be reduced in older subjects when exposed to stimulation.6 In some cases, olfactory loss may be secondary to age related appositional bone growth resulting in the pinching off of the olfactory fila as they traverse the ethmoid bone.7
Certain general diseases such as liver disease and non‐otolaryngological cancers seem to influence olfactory function.8 Another contributing factor when considering age related olfactory deterioration is mild cognitive impairment and Alzheimer's disease. Electrophysiological results of patients with Alzheimer's disease and pre‐clinical Alzheimer's disease confirm olfactory dysfunction.9

The effects of ageing on taste

Gustatory dysfunction may indeed be related to the normal ageing process. However, in many cases, what is perceived as a taste defect is truly a primary defect in olfaction. Other than smell dysfunction, the most frequent causes of taste dysfunction are prior upper respiratory infection, head injury, drug use, and idiopathic causes.10,11,12 Chewing problems associated with tooth loss and dentures can also interfere with taste sensations, along with the reduction in saliva production. When presenting to the clinician, older patients with impaired taste should be thoroughly evaluated for oral and pharyngeal disease such as candidiasis. One theory is that normal ageing produces taste loss because of changes in taste cell membranes involving altered function of ion channels and receptors.13 Taste bud loss is thought to contribute less to this problem with no relation between taste acuity and number of papillae.14 Rather than whole mouth gustatory dysfunction, regional deficits are much more common. It has been reported that there is a higher prevalence of localised losses on the tongue in elderly subjects than in young subjects.4 Despite their wide prevalence, most elderly people are unaware of regional taste deficits.

Smell and taste disorders: the consequences

The theory behind the deterioration of these senses in the elderly person has been covered, however effects on the person's lifestyle along with the dangers associated with such disorders needs to be considered. The world is a different place without the sense of smell. Pleasant experiences such as the smell of flowers in spring, the aroma of fresh coffee, or even a Sunday roast are lost forever. Contrast this with the smell of garlic on an acquaintance's breath cutting a conversation short.

Medical conditions that affect the senses of taste or smell20

Neurological

  • Alzheimer's disease
  • Bell's palsy
  • Damage to the chorda tympani
  • Epilepsy
  • Head trauma
  • Korsakoff's syndrome
  • Multiple sclerosis
  • Parkinson's disease
  • Tumours and lesions

Nutritional

  • Cancer
  • Chronic renal failure
  • Liver disease
  • Niacin deficiency
  • Vitamin B12 deficiency

Endocrine

  • Adrenal cortical insufficiency
  • Congenital adrenal hyperplasia
  • Panhypopituitarism
  • Cushing's syndrome
  • Diabetes mellitus
  • Hypothyroidism
  • Kallman's syndrome
  • Pseudohypoparathyriodism
  • Turner's syndrome

Local

  • Allergic rhinitis, atopy, and bronchial asthma
  • Sinusitis and polyposis
  • Xerostomic conditions including Sjogren's syndrome

Viral infections

  • Acute viral hepatitis
  • Influenza‐like infections
Unfortunately, smell and taste disorders in the elderly person are commonly overlooked, as they are not considered critical to life. However, this may not be the case. Decreased smell function is a contributory factor in the age related increases in accidental gas poisonings and explosions that can endanger public safety. Decreased smell and taste results in appetite suppression resulting in weight loss, malnutrition, impaired immunity, and deterioration in medical conditions.1,4,15 Nutritional problems are an important sequelae from smell and taste disorders.17 It has been reported that the elderly person requires a twofold to threefold higher concentration of salt to detect it in tomato soup.17 The tendency toward higher salt and sugar intake in the elderly diet can aggravate health hazardous conditions.18 When the sense of smell is decreased or distorted, disability and decreased quality of life are reported.19 In addition to these problems, such conditions may be responsible for a high degree of anxiety and depression in the elderly person. Anxiety in the inability to taste and enjoy food, and fears that the symptom is indicative of an underlying disorder. There is also a higher incidence of depression in those who develop anosmia.11

Investigation of smell and taste disorders

When a patient presents with a problem with their smell and taste, it is important to fully investigate the problem regardless of their age. Investigation is focused on the possible causes of such disorders as outlined in the box. This includes a detailed history and examination that may often lead to the cause of the problem, as is the case with local causes such as nasal polyposis.
More extensive testing with haematological and biochemical investigations are frequently required to discover the various nutritional and endocrine causes of smell and taste disorders.21 Radiological investigation such as computed tomography is necessary to detect neurological causes for the disorder.
It is only when other causes have been ruled out that the ageing process may be suspected as the important contributor to a smell and taste disorder.

Management of smell and taste disorders

When a patient presents with such a disorder, they initially need counselling and reassurance that they do not have a malignant disease or infection. Once diminished smell is diagnosed, the goal of management entails preventing injury related to this. Visual stimulating gas detection devices are good for those with a gas stove, as the person may not be able to smell gas leaks. Relatives or neighbours need closer involvement to check for spoiled food that if eaten could lead to food poisoning. People who have taste disorders may benefit from flavour enhancement of their foods. Flavours are mixtures of odorant molecules that can be extracted or blended from natural products, or synthesised based on chromatographic and mass spectrographic analysis of natural products. Flavour enhancers supplement, enhance, or modify the original taste or aroma of a food but do not have a characteristic taste or aroma of their own. Salt is the most widely used additive in flavour enhancement, but others such as monosodium glutamate are also commonly used. Flavour enhancement for the elderly and sick can improve food palatability and acceptance, increase lymphocyte counts, reverse or slow functional decline, and improve overall quality of life. It also has the potential to compensate for anorexia.22 An additional study found that flavour enhancement for elderly retirement home residents resulted in improved immune status as determined by T and B cell levels and improved grip strength.22 Taste and odour stimulation has also been shown to increase the rate of salivary IgA in the elderly person.23

Summary

This article has briefly summarised what is known about ageing and smell and taste disorders. More research is required in this field, along with increased awareness to discover new management options to benefit those with these disorders.

Footnotes

This article is part of a series on ageing edited by Professor Chris Bulpitt.
Funding: none.
Conflicts of interest: none declared.

References

1. Doty R L, Shaman P, Applebaum S L. et al Smell identification ability: changes with age. Science 19842261441–1443.1443 [PubMed]
2. Doty R L, Snow J B. Age‐related alterations in olfactory structure and function. In: Margolis F, Getchell T, eds. Molecular neurobiology of the olfactory system. New York: Plenum Press, 1988355–374.374
3. Murphy C, Schubert M S, Cruickshanks K J. et al Prevalence of olfactory impairment in older adults. JAMA 20022882307–2312.2312 [PubMed]
4. Bartoshuk L M. Taste. Robust across the age span? Ann N Y Acad Sci 198956165–75.75 [PubMed]
5. Doty R L, Bromley S M. Smell. In: Asbury AK, McKhann GM, McDonald WI, eds. Diseases of the nervous system. Cambridge: Cambridge University Press, 2002595–609.609
6. Cerf‐Ducastel B, Murphy C. FMRI brain activation in response to odors is reduced in primary olfactory areas of elderly subjects. Brain Res 200398639–53.53 [PubMed]
7. Kalmey J K, Thewisson J G, Dluzen D E. Age‐related size reduction of foramina in the cribriform plate.Anat Rec 1998251326–329.329 [PubMed]
8. Landis B N, Konnerth C G, Hummel T. A study on the frequency of olfactory dysfunction. Laryngoscope 20041141764–1769.1769 [PubMed]
9. Peters J M, Hummel T, Kratzsch T. et al Olfactory function in mild cognitive impairment and Alzheimer's disease: an investigation using psychophysical and electrophysiological techniques. Am J Psychiatry 20031601995–2002.2002 [PubMed]
10. Bromley S M, Doty R L. Taste. In: Asbury AK, McKhann GM, McDonald WI, et al, eds. Diseases of the nervous system. Cambridge: Cambridge University Press, 2002610–620.620
11. Moore‐Gillon V L. Abnormalities of smell. In: Mackay IS, Bull TR, eds. Scott‐Brown's otolaryngology. 6th ed. Oxford: Butterworth Heinemann, 199751–58.58
12. Miller I J. Anatomy of the peripheral taste system. In: Doty RL, ed. Handbook of olfaction and gustation. New York: Marcel Dekker, 1995521–547.547
13. Mistretta C M. Ageing effects on anatomy and neurophysiology of taste and smell. Gerodontology 19843243–248.248 [PubMed]
14. Mavi A, Ceyhan O. Bitter taste thresholds, numbers and diameters of circumvallate papillae and their relation with age in a Turkish population. Gerodontology 199916119–122.122 [PubMed]
15. Miletic I D, Schiffman S S, Miletic V D. et al Salivary IgA secretion rate in young and elderly persons. Physiol Behav 199660243–248.248 [PubMed]
16. Mattes R D, Cowart B J. Dietary assessment of patients with chemosensory disorders. J Am Diet Assoc 19949450–56.56 [PubMed]
17. Stevens J C, Cain W S, Demarque A. et al On the discrimination of missing ingredients: aging and salt flavour. Appetite 199116129–140.140 [PubMed]
18. Corwin J, Loury M, Gilbert A N. Workplace, age and sex as mediators of olfactory function: data from the National Geographic smell survey. J Gerontol Psychol Sci 199550B179–186.186 [PubMed]
19. Miwa T, Furukawa M, Tsukatani T. et al Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg 2001127497–503.503 [PubMed]
20. Schiffman S S, Graham B G. Taste and smell perception affect appetite and immunity in the elderly. Eur J Clin Nutr 200054S54–S63.S63 [PubMed]
21. Cowart B J, Young I M, Feldman R S. et al Clinical disorders of smell and taste. Occup Med 199712465–483.483 [PubMed]
22. Schiffman S S, Warwick Z S. Effect of flavor enhancement of foods for the elderly on nutritional status: food intake, biochemical indices, and anthropodometric measures. Physiol Behav 199353395–402.402 [PubMed]
23. Sciffman S S, Miletic I D. Effect of taste and smell on secretion rate of salivary IgA in elderly and young persons. J Nutr Health Aging 19993158–164.164 [PubMed]

MASTOCYTOSIS & MAST CELL ACTIVATION SYNDROME

www.mastocytosis.ca

Med. Advisory Comm: Dr Gary SIBBALD MD(Tor. 74) FRCPC ( Int.Med 78 & Derm 7m9)
Womens' College Hosp.(U.Tor)

HYGIENE in PHARMACIES

Loose pills`are usually counted on a plastic tray with a spatula. Not washed between dispensing. No gloves worn. Hands not washed.

Safer to buy branded meds in blister packs or sealed containers. Also prevents errors due to similar white pills of many generic meds.In Ontario Pharmacy "assistants" are often allowed to dispense.

Dr.A.Franklin MBBS(Lond.) DPH(Tor.)

Comments invited

1 Sept 2015

UK DAILY MAIL: NHS to introduce BAR CODES.

The technology will also help prevent never events - those deemed so serious they should never happen, including leaving surgical equipment inside a patient during an operation.
Mr Kelsey will today say the NHS is ready to implement the new plans.
He will outline a time frame by which every clinical commissioning group (CCG) must deliver their plans to eradicate the use of paper.
And he will provide clarity on what is expected, issuing a set of key digital standards that healthcare providers must implement as part of their standard NHS contract. 
We need to consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trolleys groaning with patients' notes. As well as saving precious resources, technology can dramatically reduce errors
Tim Kelsey, NHS England's national director for patients and information
By October, all discharge summaries for patients transferring from hospital to the care of their GP must be completed electronically.
NHS England said: 'This will help to ensure that a patient's transition out of hospital is as smooth and safe as possible and enable doctors and nurses to care for them more effectively straight away.'
Next year, this will be broadened out to include discharge to social care. 
Trials have shown that giving GPs instant access to discharge summaries online reduces the risk of error, allowing doctors to immediately see what drugs their patients are on and what procedures they have had while in hospital. 
The Government estimates the cost of storing and moving paper around the NHS is between £500,000 to £1 million for each trust - money which they say could be better invested in more doctors and nurses. 
'Every day, care is held up and patients are kept waiting while an army of people transport and store huge quantities of paper round our healthcare system,' Mr Kelsey will say. 
'This approach is past its sell by date. 
'We need to consign to the dustbin of history the industry in referral letters, the outdated use of fax machines and the trolleys groaning with patients' notes.
'As well as saving precious resources, technology can dramatically reduce errors. Urgent action is a moral imperative where paper is the currency of clinical practice.'
The health service aims to become paper-free at the point of care within the next five years. It means when patients turn up at appointments in both primary and secondary care, medics will have immediate access to their history, clinical notes and test results
The health service aims to become paper-free at the point of care within the next five years. It means when patients turn up at appointments in both primary and secondary care, medics will have immediate access to their history, clinical notes and test results
He will add: 'The NHS needs to get over the idea that we've had too many false starts and we can't do technology. 
'While bringing our own systems into the digital age, we must do more to help the public and clinicians take advantage of the game-changing opportunities on offer to improve outcomes for patients.'
Last autumn, the NHS set out its bold vision for the future, outlining the change needed to bring the health service into the 21st century.
It included a more effective use of technology and data to support new and improved models for delivering patient care.
Health bosses say the evidence for digitalised records improving patient safety is 'clear'.
They point to the example of electronic prescribing systems, which support clinicians to ensure the right medication is provided to the right patient in the right dosage.
Those systems have halved medication errors, yet only 14 per cent of NHS trusts currently use the technology.
In addition, a study published in the British Medical Journal, found that death rates at two major hospitals fell by more than 15 per cent when nurses were given handheld computers to monitor patients' vital signs.
The drop in mortality represented more than 750 lives saved in a single year across the two sites, which could equate to tens of thousands of lives across the NHS.