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Question 1

What is an overview of the story of Dr Bawa Garba?

Answer 1

. 18th January 2011, Jack Adcock was admitted to the Royal Infirmary Leicester after feeling unwell. He had fever, vomiting and diahroea. He had down syndrome a heart condition and was on long-term medication
. He was treated by a junior doctor Bawa Gaba who was a paediatric registrar 6 years into her specialist training.
. Jack died of sepsis and Dr Bawa Gaba was charged with gross negligence

Question 2

Give a breakdown of the events of the Dr Bawa Gaba case?

Answer 2

. Jack was given an x-ray which showed an infection. This was available at 12:30 but was seen by Bawa Gaba at 3:00. She treated him with antibiotics at 4:00 as she was extremely busy and the hospital was understaffed.
. A blood test revealed Jack had high levels of infection and inflammation but this was seen 5 hours late because of failings in the hospital system
. Dr Bawa Gaba stopped Jacks heart medication but didn’t write it down in his notes and his mother mistakenly gave him a dose at 7:00pm
. Jack suffered cardiac arrest at 8:00pm and Dr Bawa Gaba mistook him for another patient that had a DNR so she stopped ressusitation. The boy ended up dying from septic shock at 9:20pm

Question 3

What were the mistakes made my Bawa Gaba?

Answer 3

. Didn’t check the x-ray for 3 hours
. Didn’t administer antibiotics for another hour after she knew which could’ve resulted in a different outcome for him
. Didn’t write down or inform the mother not to give heart medication
. Mistook Jack for another patient and didn’t allow resuscitation
. She didn’t review results about the patient when handing over to the consultant on the next shift

Question 4

What mistakes were made by the NHS (Bawa Gaba)

Answer 4

. Understaffed and Bawa Gaba was doing the work of 2 doctors
. No notification for when an x-ray was complete
. Computer failings delayed blood work for 5 hours

Question 5

What lessons were learned from the Bawa Garba case?

Answer 5

. Changes in hospital protocol including better registration and safety concerns
. Improvements in computers and less tech failings
. Discussion about stress and work overload of doctors
. Some doctors suggested doctors should lie about when you’ve made a mistake

Question 6

What happened after the Bawa Gaba case?

Answer 6

. Dr Bawa Gaba was struck off the GMC
. many doctors organisations raised awareness about the stresses that doctors face to place her actions in the context
. The decision to strike her off the GMC was overturned
. The UK government released a set of reforms in response to the case

Question 7

What is the ageing population?

Answer 7

. An ageing population is one in which the proportion of older people is increasing
. Currently 3.2 million people over the age of 80 but will be 8 million by 2050
. Ageing populations are a result of increasing life expectancy and decreasing birth rate resulting in smaller younger generations.
. This is because of improved healthcare and a switch to diseases being the main cause of death. Decreased birth rate is because of people having fewer children and later in life

Question 8

Stats and figures about the ageing population

Answer 8

. 81.52 years is the average life expectancy
. 62 is the health life expectancy and government wants to increase this by 5 years by 2035. They would do this by decreasing the bad habits people have like smoking and bad diet and encourage healthier things like exercise
. Individuals over 85 are said to cost the NHS £7000 per person and the spending per person increases rapidly after the age of 50
. One in six elderly people have dementia as so a lot is spent on their daily care

Question 9

What are the consequences of an ageing population?

Answer 9

. Higher prevalence of chronic and degenerative diseases which can act as comorbidities and require complex treatment across different departments
. Older people have more complicated illness and require longer more repeated hopstial stays
. Increased lifespan and improved care means some will require longer care which affects need for beds and hospital capacity
. Costs for providing care increase including staffing, medication and services

Question 10

What is bed-blocking?

Answer 10

Bed blocking is the term used to describe delaying the transfer of care. An example of this could be an elderly person experiencing a fall and then it can take weeks for them to be discharged

Question 11

What is obesity?

Answer 11

. The WHO defines it as abnormal or excessive fat accumulation that may impair health
. Overweight is a BMI of 25 or over
. Obesity is a BMI of 30 or over
. BMI calculation is Weight/ Height squared

Question 12

What contributes to obesity?

Answer 12

. Incorrect food consumption
. Lack of activity
. Stress
. Lack of sleep
. Health and medication
. The environment 
. Genetics

Question 13

What is Prader-Willi syndrome?

Answer 13

. It’s a genetic condition caused by a loss of function of certain genes on chromosome 15 due to no paternal copies being inherited
. It affects the hypothalamus which is involved in hormone production leading to hormonal changes
. This leads to an insatiable appetite, that drives obesity
. No direct cure for obesity but consequences can be treated

Question 14

What is Prader-Willi syndrome?

Answer 14

. It’s a genetic condition caused by a loss of function of certain genes on chromosome 15 due to no paternal copies being inherited
. It affects the hypothalamus which is involved in hormone production leading to hormonal changes
. This leads to an insatiable appetite, that drives obesity
. No direct cure for obesity but consequences can be treated

Question 15

What are the consequences of being obese to the person?

Answer 15

. Increased risk of chronic conditions like fatty liver disease, heart disease, cancer etc..
. Worse mental health outcomes and poor quality of life
. Affect quality of care as some doctors have been shown to have weight bias which can affect treatment
. Affect ability to perform exercise and participate in certain activities

Question 16

What are the consequences of being obese to the person?

Answer 16

. Increased risk of chronic conditions like fatty liver disease, heart disease, cancer etc..
. Worse mental health outcomes and poor quality of life
. Affect quality of care as some doctors have been shown to have weight bias which can affect treatment
. Affect ability to perform exercise and participate in certain activities

Question 17

What are the consequences of being obese to the NHS?

Answer 17

. Overweight and obesity-related conditions are costing the NHS £6.1 billion per year
. Over the last 5 years, there have been 20% increase in hospital admissions linked directly to obesity
. Cost of campaigns seeking to prevent obesity alongside that of treatment
. 1 in 5 children leave primary school with obesity
. 2/3 of adults also living with obesity

Question 18

What is the sugar tax?

Answer 18

. A tax implemented by the government in 2018 which charges extra money if the sugar in a drink is above the threshold.
. It has been successful in raising awareness and many companies have reduced the amount of sugar added to their drinks.
. Average household sugar intake was reduced by 10%

Question 19

What is the MMR vaccine?

Answer 19

. MMR is measles, mumps, rubella
. Vaccine is given to young children around the first 12 months. Decision to vaccinate is up to carer not child
. Combining the 3 vaccines reduces the time the 3 diseases are vaccinated against

Question 20

What is Andrew Wakefields paper?

Answer 20

. In 1998, Andrew Wakefield ( a surgeon) published a paper that showed a link between the MMR vaccine and autism
. He called for suspension of the triple vaccine and suggested a single vaccine
. His work was discredited an he was struck off by the GMC but the vaccine uptake fell dramatically

Question 21

What were the problems with Andrew Wakefields paper?

Answer 21

. No other research replicated his results
. Evidence was found that Wakefield applied for a patent on a single-jab measles vaccine
. Former student of Wakefield said he ignored lab data that went against his hypothesis
. Small sample size, only 12 cases
. Some children showed symptoms after a long time but report claimed effect was immediate

Question 22

What were the consequences of the MMR scandal?

Answer 22

. MMR vaccine coverage fell to as low as 80% in 2003-2004. 2005 and 6 showed high numbers of measles cases
. Continued worries and persistent doubts about vaccine safety, also affected the uptake of other vaccines
. This also had a huge negative impact on people with autism as it perpetuates that it’s a terrible thing to happen and that people would rather risk a deadly disease

Question 23

What is artificial intelligence?

Answer 23

The term used for technology performing actions thought to require intelligence

Question 24

How is AI being used in medicine?

Answer 24

. Medical diagnosis - offering better long-term outcome
. Radiotherapy - doses how much to give to a specific tumour
. Virtual nurses - device called current that measures stats to give doctors updates on patients health
. Robotic surgery - using these can have a reduction in surgical complications

Question 25

Pros and cons of AI in medicine

Answer 25

. Better patient outcomes with robotic surgery
. Earlier diagnosis, more chance of recovery
. Better monitoring of health

. How will data be used?
. Could there be failures of the robots?
. Is this too impersonal when coming to treat patients - robots have no empathy

Question 26

What is prEP?

Answer 26

. Stands for pre-exposure prophylaxis and is the drug given to HIV negative patients that have sexual contact with a HIV positive person only if they have a large viral load or aren’t on medication.
. 99% effective if taken very regularly.

Question 27

Advantages of taking PrEP?

Answer 27

. Effective in helping people whpo are HIV negative maintiain that status if they have a positive partner
. No side effects to the majority of people
. Encourages HIV positive people to live a relatively normal life

Question 28

Disadvantages of PrEP?

Answer 28

. Serious side effects on kidney function and bone health
. Might not always be effective if drugs aren’t taken often
. PrEp might be needed for HIV positive people more than for their partners
. Other STIs could become more common as unprotected sex

Question 29

When did Brexit occur?

Answer 29

.The UK left the EU on the 31st of January 2020 with a transition period from a month prior

Question 30

What did the government promise to the NHS?

Answer 30

.That an extra £350 million would be spent on the NHS however they didn’t dictate how this would be spent.
. In 2019, they increased the budget to £33.9billion by 2023 and an immediate injection of £6.2billion.
. £20.9 billion has been allocated for 2021-2022

Question 31

What is the staffing crisis?

Answer 31

. 5000 nurses left the UK from 2017-2019 with many identifying Brexit as the reason
. There was already a shortage of 40,000 nurses putting a larger strain on the NHS. Number of European workers expected to fall due to harsher immigration laws and the salary decreasing
. More people coming from outside Europe to work as nurses
. As of October 2021, 1 in 5 nurse positions remains unfilled but the application to study nursing has increased by 21%

Question 32

What is stockpiling medicine?

Answer 32

. The UK built a stockpile of drugs and medical supplies but these were used up by the COVID pandemic.
. In September 2021, the issue of importing medicine after Brexit was still an issue and concerns had been raised about the shortage of drivers

Question 33

What are BAME staff?

Answer 33

. Black and minority ethinic staff make up 19.7% of the NHS staff

Question 34

What inequalities do BAME staff face?

Answer 34

. Unequal representation of board members
. Recruitment problems
. Less like to be supported in a disciplinary process
. Likelier discrimination

Question 35

What is the NHS doing to help BAME staff?

Answer 35

. NHS people plan for more representation to reduce unconscious bias including supporting them more

Question 36

What inequalities do BAME patients face?

Answer 36

. Deatn during childbrith, a black woman 5 times more likely to die in childbirth than a white woman
. Detrimental health outcomes because doctors dismiss their concerns

Question 37

Impact of COVID-19 on BAME?

Answer 37

. Disproportionate mortality. 95% of doctors in the first month that died of COVID were BAME staff
. Scared to raise concerns of COVID from fear of discipline

Question 38

What are the 3 types of A&E?

Answer 38

. Type 1 departments like the 24 hour service led by consultants
. Type 2 is dedicated to specific specialties like dental
. Type 3 is minor injuries and illnesses

Question 39

What happened to A&E waiting times?

Answer 39

. Failed to reach 4 hour standard due to financial austerity and understaffing
. Not met the standard since 2013

Question 40

Why are patients waiting longer?

Answer 40

. Rising A&E attendances
. Fewer hospital beds
. Age of patients 
. Unneccesary attendances
. Bed blocking
. Staffing shortages

Question 41

What are the issues within primary care right now?

Answer 41

. GP shortages
. Incrasing demand for GPs
. Recruitment issues, Matt Hancock offered to hire 5000 new GPs by 2020 but this target was not met. 1500 places in medical school were also made available
. Long waits for appointments
. Unsafe patient levels for each doctor

Question 42

What are solutions to help primary care services?

Answer 42

. Encouraging medical students to become GPs
. International recruitment
. Payment schemes for new GPs

Question 43

Has medical cannabis been legalised?

Answer 43

. From November 2018, specialist Doctors in England can prescribe cannabis dervided medicine in exceptional circumstances
. Products with cannabis have been reclassified as Schedule 2 which means it has potential medical uses in children with severe epilepsy as well as adults with MS that have muscle stiffness, only if all other treatments fail

Question 44

What happened to Billy Caldwell?

Answer 44

. Billy was prescribed canabis oil by his GP to treat his severe epilepsy in 2017.
. He couldn’t get it in the UK so had to fly over to Canada to get his treatment but when coming back to england, his drugs got confiscated which led to him having seizures
. There was a huge public outcry and eventually he was granted a lifelong prescription of cannabis oil and has been in remission for 8 years