Rail fare hike: the 10 worst London commutes

Today's spike in train fares hits some journeys harder than others.

A moment's silence for those of us who have to get around by train. Over the last month we have had to deal with floods, signal failures, staff shortages and overcrowding. Now comes the news that rail fares are to be hiked once again.

The average rise is only 4.3 per cent, but as long as they stick to this average, train companies can increase the prices of some tickets as far as they like. The result is uneven, some routes are hit worse than others. Campaign groups point out that this is the 10th successive above-inflation rise, London commutes being particularly affected. Here are the 10 worst hit London travel routes:

1. Sevenoaks to London has gone up 87 per cent in the last 10 years. Weekly tickets have gone from £41.50 to £77.80 and season tickets from £1,660.00 to £3,112.00.

2. Ashford International in Kent to London has gone up 80 per cent in the last 10 years. Weekly tickets have gone from £66.50 to £119.50, and season tickets from £2,660.00 to £4,780.00.

3. Bracknell to London has gone up 78 per cent in the last 10 years. Weekly tickets have gone from £55.70 to £99.00, and season tickets from £2,228.00 to £3,960.00.

4. Canterbury to London has gone up 78 per cent in the last 10 years. Weekly tickets have gone from £67.50 to £120.30, and season tickets from £2,700.00 to £4,812.00

5. Tunbridge Wells to London has gone up 71 per cent in the last 10 years. Weekly tickets have gone from £60.30 to £103.30, and season tickets from £2,412.00 to £4,132.00.

6. Maidstone to London has gone up 68 per cent in the last 10 years. Weekly tickets have gone from £59.00 to £99.00, and season tickets from £2,360.00 to £3,960.00.

7. Tonbridge to London has gone up 68 per cent in the last 10 years. Weekly tickets have gone from £56.00 to £94.20, and season tickets from £2,240.00 to £3,768.00

8. Gillingham to London has gone up 67 per cent in the last 10 years. Weekly tickets have gone from £55.10 to £91.80, and season tickets from £2,204.00 to £3,672.00.

9. Hastings to London has gone up 59 per cent in the last 10 years. Weekly tickets have gone from £72.00 to £114.60, and season tickets from £2,880.00 and £4,584.00.

10. Eastbourne to London has gone up 58 per cent in the last 10 years. Weekly tickets have gone from £68.00 to £107.60, and season tickets from £2,720.00 to £4,304.00.

The data came from Campaign for Better Transport, and was calculated using the weekly and season ticket prices between 2003 and 2013. It took inflation into account. (There is not yet a complete data set for travel routes outside London).

Stephen Joseph, the executive director of Campaign for Better Transport, said:

“These fare spikes are bad for people and bad for the environment. Once again, the Government is talking tall but walking short when it comes to ensuring the transport sector tackles climate change. If it is serious about tackling climate change, it must ensure train journeys are an attractive, affordable option for people.”

The average rise in fares is 4.3 per cent. Photograph: Getty Images
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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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