Dear Theresa May and Michael Fallon, this is how you should fix the navy… fast

On 25th November the professional head of the Royal Navy delivered a robust defence of the service, upbeat about its current work and its future. He was right to make his point, this is his job and leaders need to show confidence. The sailors of the RN are doing an outstanding job and deserve to believe in their future. In reality they are making do with insufficient ships, submarines, aircraft and people but somehow just about manage to keep on delivering on a daily basis.

The RN has much to be proud of and look forward to. Some fine new vessels are on their way, not least 2 large aircraft carriers, but there are so many dangerous gaps in capability that their fighting credibility is in question. Without enough escorts the carriers are in danger, without enough manpower, mass and appropriate armament the whole fleet is at risk of bloody defeat in a serious conflict. You are in danger of creating a paper tiger. It is time for government to act to prevent disaster.

This is not just the view of a few eccentrics, nostalgic for the days when Britannia ruled the waves, but the opinion of the cross-party House of Commons Defence Select Committee which stated bluntly that “the UK already has a woefully low number of vessels… it lacks the maritime strength to deal with the threats we face right now, let alone in the future”

Trumpeting your achievement in meeting the NATO minimum 2% of GDP on defence does not cut it. Firstly it was set down as a “minimum”, not a target. Secondly, comparing ourselves favourably with Europeans who are even more deluded about defence expenditure than ourselves is futile. And thirdly, everyone knows that to achieve the 2% target has involved disingenuous Treasury accounting tricks which do not translate into much strengthening of the front line.

To be fair SDSR 2015 was better than many previous defence reviews and there has been a small increase in spending. Unfortunately this will not provide the remedy for at least 3 decades of cock-ups, neglect and declining funding that needs addressing urgently. Most if this is not your fault, but as you yourself say, it is the first duty of any government to protect its citizens.

To renew the Royal Navy properly will require a significant increase in expenditure, to pretend otherwise unrealistic and negligent. This is going to cost real money and impact the public finances – get used to it.

You will have to raise taxes, make cuts elsewhere or increase borrowing and explain this to very sceptical parts of the electorate and media, but that is your job. The good news is you won’t have to continue the trying to deceive the public about the true state of our navy. Plus it will create a lot of jobs and stimulate the economy in places that need it, particularly in Scotland, the North and South West of England. Above all it will start to restore some real security to a nation that is utterly dependent on the sea and staring down the face of growing worldwide threats. The Americans have been paying for much of our defence for a long time but that maybe coming to an end. Finally, learn lessons from history, greater expenditure now will act as a deterrent which may prevent future wars and conflict which would be far more costly in both human life and treasure.

“Nothing is more important than defending our country and protecting our people. With increasing threats to our security” Michael Fallon

Immediate actions

• Manpower – Funding for an emergency recruitment drive. Above inflation pay rises, at least for ratings. A complete new bonus structure with golden handcuff deals that incentivise experienced people to remain serving, with large retention bonuses paid at 3 yearly intervals. Further improve accommodation and family support where needed. Consider any other radical option that will help recruit and retain personnel. Target minimum strength of RN to be at least 45,000 plus reservists.
• All 13 Type 23s fitted with towed array sonar, Sea Ceptor and to have life-extension refits.
• Purchase of interim canister-launched anti-ship missile to replace Harpoon on all Type 45 and Type 23s.
• Type 45 propulsion rectification programme to begin immediately. (Starting with HMS Dauntless) and Mk 41 VLS to be fitted to Type 45s at the same time.
• Upgrade the 12 Merlin helicopters currently in storage to Mk2 standard.
• Order another 12 Wildcat helicopters and fit all 36 of them with dipping sonar.
• Additional purchases of key equipment like Phalanx, Torpedo defence system, decoys, etc. End the practice of sharing major equipment between ships. Every ship allocated their own complete set of kit with back-up spares held ashore.
• Expand missile, torpedo and ammunition stocks. 
• Expand general stores of spares and replacement parts and re-establish an in-depth and resilient logistical support system for the navy.
• The whole defence procurement apparatus to be put into special measures almost akin to a war-footing. All defence projects to have senior managers (Civil Servants and those in uniform) made to stay in post for minimum of 5 years – well rewarded for success or heavily penalised for failure in meeting key performance parameters and deadlines. 
• Ban all defence lobbying interests from Parliament and MoD. Play hardball with BAE Systems and, if necessary part-nationalise or break up its monopoly, if that is what it takes to make it serve the interests of defence ahead of profit.

Medium term actions

• Build the 13 Type 26 frigates on the Clyde as originally planned and deliver at least one ship a year from 2022.
• Start Type 31 build program with target of at least 8 ships. Bring the best design proposal to maturity as soon as possible and utilise any available shipbuilding capacity, primarily in England.
• HMS Queen Elizabeth & Prince of Wales to be fitted with Sea Ceptor as soon as possible.
• Cooperative engagement capability to be fitted to Type 45, Type 26 and Aircraft Carriers and integrated with F-35.
• If possible, accelerate purchase of F-35s so we have at least 60 in service by 2025.
• RN to be given full operational control of all F-35s, with QE aircraft carrier tasking given first priority.
• Purchase Tomahawk Land Attack missiles to be carried by Type 45 and Type 26.
• Purchase SM-3 missiles to give Type 45 anti-ballistic missile capability at earliest opportunity. 
• Retain all 4 Batch 1 River class OPVs to be dedicated to UK territorial waters patrols and recruit additional reservists to man them.
• Upgrade all 5 Batch 2s OPVs with lightweight towed array sonar, Phalanx and UAVs and deploy one of each permanently in the Falklands, the Caribbean, Gibraltar and Bahrain
• Purchase LRASM and ASROC for Type 45 / Type 26.
• HMS Ocean to go into reserve in 2017 but begin immediate work on like-for-like replacement, built to merchant standards, probably in overseas yard.
• Large budget to be dedicated to purchase and develop unmanned systems and operating doctrine. Aim that RN should become a world-leader in unmanned naval technology by 2030 (with attendant benefit for UK industry).
• HMS Bulwark to be returned to service with HMS Albion as soon as refit complete.
• Purchase and begin merchant ship conversions to replace RFA Diligence and RFA Argus.
• Create a black projects fund for classified naval projects likely in the realms of, underwater warfare, special forces, electronic and cyber warfare.  

Long-term actions

• Build an 8th Astute class submarine if it can be fitted around Dreadnought class construction schedule.
• Begin purchase, lease or license-build of at least 6 AIP conventional submarines from Germany or Sweden.
• Integrate widest possible range of missiles and munitions for F-35 including an anti-ship missile.
• P-8 Maritime Patrol Aircraft put under RN operational control and fully equipped with ability to drop Stingray torpedos and fitted with an anti-ship missile
• Negotiate for 2nd batch of P-8s to bring strength up to 18 aircraft.
• Investigate purchase of V-22 osprey for possible air-air-refuelling of F35, carrier onboard delivery and amphibious assault.
• Begin building 4 x solid stores support ships at Babcock Rosyth as soon as HMS Prince of Wales is complete.
• Replace LCUs with faster craft and upgrade Royal Marine vehicles as needed.
• HMS Albion & Bulwark to be replaced with LHD (similar to Spanish Juan Carlos).
• MHC programme fully funded to develop new generation of mine warfare vessels and unmanned minehunting systems.
• Expand naval science and research, work with US on development of rail gun and laser technology.

Footnote

This ‘shopping list’ is a guideline only, there are plenty of well qualified people who could to refine it further. Broadly speaking this builds on the existing equipment plan and capabilities. This is not a radical departure from current structures or strategy, rather a series of fixes to repair a badly hollowed-out fleet and give more strength in depth. It would be erroneous to perceive this an unjustified major re-armament programme, in reality it would only restore the strength of the RN to approximately what it was in the late 1990s.

 

Related articles

• NATO spending target ‘met’ by MoD accounting changes (BBC)
• Britain’s defences put at risk as navy warships number is ‘woefully low’ warn MPs (Express)
• We can’t keep running down the Navy by stealth, and pretending that nothing has changed (Andrew Wood, ConservativeHome)
• The Royal Navy is Britain’s most effective means of promoting and defending itself (Mark Fox, ConservativeHome)
• The Royal Navy risks having ‘pathetically low total’ of ships, warn MPs (Guardian)

from Save the Royal Navy http://www.savetheroyalnavy.org/dear-theresa-may-and-michael-fallon-this-is-how-you-should-fix-the-navy-fast/

The navy replies to avalance of bad news stories

Beset by several weeks of bad news stories, the First Sea Lord has delivered a speech highlighting how the service is currently working hard around the world and fulfilling the tasks the Government has set out for it. There are undoubtedly very serious problems facing the service now and in the future which we will continue to highlight and campaign to be addressed. However the RN of today is still in the front rank of navies, its people are getting on with the job and should be commended. The Admirals speech is reproduced in full below.

“Reading the news over the past few days you’d be forgiven for thinking that the Royal Navy had packed up and gone home, leaving Britain undefended. The reality is altogether different, and should be judged by action not by commentary. As First Sea Lord, I owe it to our sailors and marines, many of whom are preparing to spend Christmas away from their loved ones, to ensure the country recognises how hard they are working for our island nation.

Today, the Royal Navy has 30 ships and submarines, and over 8000 of our young men and women – regular, reserve and civilian – committed to operations at home and around the world.

The Royal Navy continues to fulfil our standing commitments, from supporting British overseas territories in the Caribbean and the Falklands to the Royal Marines’ ongoing support to counter-terrorism at home.

A ballistic missile submarine is currently on patrol deterring state based threats against the UK and our NATO allies, as has been the case 24 hours a day, every day, for the last 47 years.

In Northern Europe and the Baltic, we are responding to the highest level of Russian naval activity since the end of the Cold War. In the Mediterranean and the Aegean, we continue to work alongside our European partners to counter arms-traffickers and people smugglers, and to stem the flow of migrants. Meanwhile in the Gulf are working to protect international shipping in a region which is essential to the UK’s economic security.

Sadly the world is less certain and less safe. But our sense of responsibility has not changed. The Royal Navy may be smaller than in the past but has a strong future so this is no time to talk the Navy down.

The Royal Navy does have challenges, in people, budgets and equipment, but these must be put in perspective. The Royal Navy’s challenges are those of a first-rate Navy. You don’t hear about the same issues in many other navies – and believe me, they exist – because they don’t operate with the same sophistication or expectation.

The Type 45 destroyer is a case in point. It is a hugely innovative ship, and the propulsion systems have turned out to be less reliable than originally envisaged. Money is now in place to put this right, but what is beyond doubt is that these ships offer one of the best anti-aircraft capabilities in the world. If they weren’t up to the job then the US and French navies would not entrust them with protection of their aircraft carriers in the Gulf.

The UK, like any developed economy, has to control public spending. Difficult decisions had to be taken to balance the books and retiring the Harpoon missile system was one. That weapon was reaching the end of its life, which is why we are exploring the advanced technologies that will take its place. Last month the Royal Navy held the largest international gathering of autonomous systems ever staged, and we will shortly trial both an energy weapon and artificial intelligence at sea. These are the technologies that will maintain our superiority over more conventional navies.

We must also ensure that the focus on our current challenges does not obscure the scale of investment which is currently taking place or its significance for the UK’s place in the world. With last month’s cutting of steel for the future HMS Dreadnought, the renewal of the nuclear deterrent has begun, but it’s the impending arrival of the Queen Elizabeth-class aircraft carriers, and their air group of fifth generation fighters, that really mark the beginning of a new era.

If you need a further reminder of the practical and symbolic power coming our way, consider the international significance attached to the recent deployment of the Russian carrier Kuznetsov and her battle group to the Mediterranean.

When the French carrier Charles De Gaulle enters refit at the beginning of next year, Western Europe will be left without a large aircraft carrier for operations, which again highlights the strategic value that two carriers flying the White Ensign will bring to our nation, and our partnerships, in the decades ahead.

Backed by a commitment to meeting NATO’s requirement to spend 2% of GDP on Defence, last year’s Defence Review mandated the necessary supporting components in place to ensure a balanced Fleet, including new F35B Joint Strike Fighters, Type 26 frigates, Maritime Patrol Aircraft and Royal Fleet Auxiliary ships.

Crucially, the Government has repeatedly stated its ambition to grow the size of the Royal Navy by the 2030s through the construction of a new class of General Purpose frigate. This will be a complex warship, able to protect and defend and to exert influence around the world, but deliberately shaped with lessons from industry to make it more exportable to our international partners.

This is hugely significant. For most of my 38 year career, the story of the Royal Navy has been one of gradual, managed contraction. Now, at long last, we have an opportunity to reverse this trend, rebuilding in particular resilience in our destroyer and frigate numbers, the backbone of a fighting Navy.

This would also permit a more frequent presence in parts of the world in which we have been spread thin in recent years in order to support the UK’s growing global economic ambitions.

So, rest assured, I intend to work with the Government in the coming months and years to deliver their ambition for a larger Navy. Only this will ensure the Royal Navy can continue to deter our enemies, protect our people and promote our prosperity in these uncertain times.”

Admiral Sir Philip Jones, First Sea Lord

from Save the Royal Navy http://www.savetheroyalnavy.org/the-navy-replies-to-avalance-of-bad-news-stories/

Will the Type 26 frigate deliver a punch commensurate with its price tag?

The quality of a warship should never be judged purely on its armament. There are many other factors to consider such as its sensors, electronics, propulsion, construction quality and above all the standard of its crew. But in this article we will focus primarily on the weapons fit of the Type 26.

Under mounting pressure to just get on with it, the MoD finally announced on the 4th November that construction work on the Type 26 frigate will begin in the Summer of 2017 (Subject to further contract negotiations of course). Protracted design and development of this ship has been underway for more than 18 years and it will still be at least another 5 years before the RN receives the first ship. A project that began with the aim of developing an affordable and exportable frigate has gradually spiralled in size and complexity into an expensive ‘high-end’ vessel with export potential that will, at best, probably be limited to licensing of the design to foreign builders.

The Type 26 is a conservative design and the majority of its systems will have been proven on other platforms before it ever goes to sea. Some of the equipment fitted to the Type 23 frigates will even be transferred directly from them as they decommission to the new ships. The colossally expensive Type 45 project included 80% new systems and experience dictated a low-risk solution for the new frigate. This approach seems sensible but appears to be at odds with a large approximate price tag of around £750 Million for the each of the first three ships. Defining the actual price of a warship is a complex task but what is certain is the MoD expects to spend around £8 Billion in the next decade to buy 8 Type 26 and “at least” 5 Type 31 frigates.

The Type 26 has almost 40% greater displacement than the Type 23 but despite being separated by 30 years of technological development, the ships are broadly similar in general arrangement. Equipment fit is roughly equivalent, apart from two very significant additions to the Type 26; the ‘mission bay’ and the space allotted for the Mk 41 vertical launch system. Together with the Chinook-capable flight deck, these elements have resulted in a large ship.

The mighty Mk 41

The Type 26 design made public in 2012 showed that traditional canister-launched anti-ship or land-attack missiles seen on early design concepts had been abandoned. In its place were 24 Mk 41 Vertical Launch System (VLS) cells to be fitted just forward of the bridge. The US-made Mk 41 VLS is in use by 13 navies with over 12,000 cells fitted to ships worldwide. At sea since the 1980s, the Mk 41 has been continually developed and is the primary weapons system for the majority of the US navy’s surface fleet. The largest ‘strike-length’ cells allow warships to carry a diverse range of missiles and its addition to the Type 26 appears to open up many exciting options for the armament of the new frigate.

Unfortunately there is currently not a single missile type in the UK inventory that is currently compatible with the Mk 41. Without a commitment to purchase new munitions, the first operational Type 26 may find much of its armament is fresh air. The RN is no stranger to its warships being fitted “for but not with” items of equipment. Unfortunately endless rounds of cuts and austerity have often seen the failure to ever fit that equipment. It is an unhealthy peacetime mentality that allows warships to be put to sea not fully equipped. An MoD Type 26 infographic published on the day of the steel-cutting announcement omitted the Mk 41 entirely but the RN has since confirmed the cells will definitely be fitted.

When selecting vertical launch systems, The RN is in a complicated position. The Type 45 carries the French Sylver A50 VLS silo for its Sea Viper missiles. It has the space available to retro-fit either larger Sylver 70 cells and/or add an additional 16 Mk 41 cells. Commonality of equipment is always desirable and more economical so this creates a dilemma about whether to invest further in the Sylver system and its more limited munitions options or invest in the ubiquitous American Mk 41.

The Future Cruise & Anti-Ship Weapon (FCASW) is an Anglo-French project in the early stages of developing a possible single solution to replace Harpoon and SCALP/Tomahawk. A ‘technology demonstrator’ is due in 2019 but it will be sometime after 2030 and well after the first Type 26s are at sea before an operational anti-ship missile might be a reality. Even if the project survives the stresses of international co-operation it cannot deliver in time to avoid further dangerous capability gaps. Political enthusiasm for defence co-operation with France, the weakness of the pound against the dollar and now the election of Donald Trump has created a climate that further favours FCASW over US-made munitions such as LRASM. It must be hoped that the FCASW missile will be compatible with Mk 41.

It has recently become clear that the RN has no plan or funding available to replace the obsolete Harpoon Block 1C anti-ship missiles in its inventory when it goes out of service in 2018. As discussed in a previous article, this will put the RN in the absurd and laughable position of having a surface fleet with no guided weapons capable of sinking warships larger than corvettes. Either an interim cansiter-launched missile must be purchased for the Type 23s and 45s or the RN could be without ASuW capability for more than 15 years until FCASW is available. Alternatively the Mk 41 launched Long Range Anti-ship Missile (LRASM) could be purchased for the Type 26, reducing the gap slightly. The Mk 41 on the Type 26 assumes great significance, as this is its only option for embarking a heavyweight anti-ship missile.

• Armament
• Mission bay
• ASROC
• LRASM

• 

  CGI showing the general arrangement of equipment sited on the Type 26 foredeck.

• 

  The mission bay can carry an interchangeable selection of equipment tailored to suit the ship’s particular mission. This could include additional RHIBs, assault boats, shipping containers and unmanned vehicles.

• 

  Anti-submarine torpedo attached to a rocket. A RUM-139 ASROC launched from Mk 41 VLS aboard a US Navy destroyer. The RN had a similar system in service during the 1970-80s called Ikara.

• 

  Mock up showing the LRASM being fired from Mk 41 VLS. The missile is currently under development and will probably become the ‘gold standard’ amongst Western anti-ship missiles. It will be available long before the FCASW project bears fruit.

The adaptable mission bay

The relatively simple concept of an ‘mission bay’ has already been adopted by several navies but this will be a first for the RN. More than just an empty space, it includes an overhead gantry crane for moving equipment on and off the ship while alongside or at sea. Shock-resistant mountings for ISO shipping containers that could house sensitive electronics are also included. Unmanned vehicles carried in the mission bay offer the most potential to expand Type 26 capability. Provided the RN is given the funds to invest properly in unmanned systems, off-board, networked systems for surveillance, mine-warfare and anti-submarine warfare will dramatically extend the reach of the ship.

Can find submarines, but can it kill them?

The primary role of the Type 26 is submarine hunting. With an acoustically-quietened hull and machinery matched with sophisticated towed array sonar will likely make for one of the worlds best submarine hunters. Having detected the submarine, the Type 26 the helicopter is the only option for attacking the contact. The Merlin Mk2 helicopter is an excellent anti-submarine platform with good endurance, speed and its own sonar to localise the submarine contact. If the Wildcat helicopter is embarked instead, it can carry light anti-shipping missiles (that the Merlin cannot) and torpedoes but has no dipping sonar. Wildcat lacks any means of locating a submarine other than visually or with bearings provided by the frigate.

Unfortunately any helicopter takes time to get airborne and may sometimes be unserviceable or cannot be launched in severe weather. The Type 23 is fitted with the Magazine Launched Torpedo System (MLTS) which allows the ship to fire Stingray anti-submarine torpedoes from an internal magazine. The Type 26 will not have this capability. This is something of a weapon of last resort as the ship would likely have already been attacked by the submarine if it was within range of this system. A very desirable alternative would be to acquire the American RUM-139 ASROC. This is a rocket that can accurately deliver a torpedo from the Mk 41 VLS out to a range of up to 22km from the ship in a matter of seconds. This gives a very reliable 24 hour ASW capability and can prosecute fleeting sonar contacts. The RUM-139 would need to be adapted to carry the Stingray instead of the US Mk 46 equivalent but this would probably not be too problematic. Obtaining funding for this weapon seems like an outside possibility but highly desirable for a warship who’s primary role is escorting highly valuable targets such as QE class aircraft carriers.

Gunnery upgrade

The Type 26 will finally see the replacement of the 4.5inch / 114mm Mark 8 Mod 1 Gun fitted to most RN surface escorts since the early 1970s. The 5 inch / 127mm Mark 45 Mod 4 Gun will provide longer range, better rate of fire and a wider selection of modern ammunition types. The option of extended-range and precision-guided shells could considerably enhance the Type 26 in the Naval Gunfire Support role.

In summary

When the Type 26 finally emerges in the mid 2020s it will undoubtedly be a big gain in capability over the Type 23. The mission bay offers flexibility and the ability to host unmanned systems that will be critical to future developments in naval warfare. Directed Energy weapons are likely to feature on many of the worlds warships by the 2030s. The size of the ship provides a good margin for future upgrades and space to add additional electrical generation to support DE weapons. Its credibility as a submarine hunter is not in doubt but it is the funding and selection of munitions for the Mk 41 VLS that will really define how powerful these ships can be and if their hefty price tag has fully been justified.

Related articles

• The surface escort conundrum (Save the Royal Navy)
• Plans firm up for the Royal Navy’s new Type 26 frigates (The Engineer)
• Type 26 Capabilites (Think Defence)
• Lockheed Martin eager to see LRASM on Type 26 Frigates (Navy Recognition)

from Save the Royal Navy http://www.savetheroyalnavy.org/will-the-type-26-frigate-deliver-a-punch-commensurate-with-its-price-tag/

Being a Reservist Peacekeeper: Part Three

Army Reservist Private Belinda Houghton (25) from Blackpool is an Army medic currently serving with the 4th Battalion The Duke of Lancaster’s Regiment as part of the United Nations Forces in Cyprus (UNFICYP) mission. The dark nights are drawing in even here in Cyprus which means the summer is truly over and Christmas is looming. […]

from The Official British Army Blog https://britisharmy.wordpress.com/2016/11/23/being-a-reservist-peacekeeper-part-three/

Soldier to officer: Week Six

Hayley Larcombe served in the British Army as a qualified nurse for nine years. After a successful career, including deployments to Afghanistan and Kenya, she decided to apply for a commission into the Queen Alexandra’s Royal Army Nursing Corps as an officer. She was successful at the Army Officer Selection Board and has recently started […]

from The Official British Army Blog https://britisharmy.wordpress.com/2016/11/22/soldier-to-officer-week-six/

Soldier to Officer: Part Five

Hayley Larcombe served in the British Army as a qualified nurse for nine years. After a successful career, including deployments to Afghanistan and Kenya, she decided to apply for a commission into the Queen Alexandra’s Royal Army Nursing Corps as an officer. She was successful at the Army Officer Selection Board and has recently started […]

from The Official British Army Blog https://britisharmy.wordpress.com/2016/11/18/soldier-to-officer-part-five/

The medical facilities and anticipating trouble

The irony is that even if now the medical facilities are more, we find it difficult to take an appointment with a family doctor. In the past, it was easier to get an appointment and to treat the disease. But now we take more time to consult a doctor. There are many reasons for this growing trend. The major reason is that now we prefer the anticipatory medicines. When we experience some symptoms, we anticipate the disease and take the medicine on our own to improve the condition instead of visiting a doctor.

The process is time -consuming and the success rate is not high. When some get rid of the symptoms others find it reoccurring. But still, we go for this option. One can understand it better with the example of Richard Morrell. This war veteran suffered from the rheumatic fever. This fever damaged his mitral valve and that caused a heart murmur. He did not realize it until FFI examination. Fit and Fee from Infection examination revealed his medical condition while joining the army. Another recruit also failed to qualify the medical test.

Yawning 

In a column, there was a report that a gentleman got excessive yawning in five minutes and that caused an ache in his ribs. The prolonged yawning might be the sign of the hyperventilation syndrome, but many of us presume it psychological. The disturbed functioning of the brain might be the reason as well. If it keeps reoccurring then that might cause breathlessness and you might need to visit ENT surrey.

It works

A dedicated squash player of forty once got pain in the right knee and that created complications for his practice. He started experiencing pain while practising. His partner, who was the retired pharmacist, suggested him to take culinary spice turmeric regularly two grams daily to reduce the pain and inflammation. He said it will work better than the anti-inflammatory drug. It worked and now he is fit even in the early seventies.

The post The medical facilities and anticipating trouble appeared first on RNMS Stretcher Carry.

from RNMS Stretcher Carry http://www.rnmsstretchercarry.org.uk/medical-facilities-anticipating-trouble/