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Flashcards in Current Issues and News Deck (31)
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1
Q

https://www.themedicportal.com/application-guide/the-nhs/challenges-facing-the-nhs/

A

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2
Q

https://www.themedicportal.com/nhs-hot-topics-private-healthcare-and-privatisation/

A

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3
Q

https://www.themedicportal.com/application-guide/medical-school-interview/nhs-hot-topics-2018-19/

A

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4
Q

What are some challenges facing the NHS right now?

A
  • Ageing population
  • Growing population
  • Evolving healthcare needs -> Obesity and antibiotic resistance
  • Progress in medical technology costs the NHS at least an extra £10bn a year
  • Closure of local services due to centralisation pushes
  • Increased reliance on privatised services
5
Q

Brexit

A

FOR
• Possible increase in NHS funding from the reduced cost of EU membership fees
• Less pressure on the NHS from migrants BUT see counter-point
• Could reduce some racism
AGAINST
• Reduced funding for research and less flow of scientists -> UK received over 3 billion euros more from the European Science Budget than it put in
• Worker shortages -> Number of nurses from EU countries applying to work in the UK has fallen by 96% + 45% of EEA doctors were considering leaving the UK as a result of the Brexit vote
• Migrants actually bring in taxation money and are often employed by the NHS itself
• Makes cross-border care more difficult
• Possible shortages of radioisotopes and other supplies, which are being stockpiled at a huge cost
• Xenophobic rhetoric of campaign
SOLUTION
• Second Brexit referendum mirrors the idea of informed consent

6
Q

7-day NHS

A

WHAT
• Study suggested that patients admitted on a weekend suffered 15% greater mortality than on weekdays
• Survey was disputed for not considering all factors
• Theresa May wants: (1) GPs to be open on Saturdays and Sundays, as well as longer hours. (2) Better provision of services in hospital on weekends, including seeing consultants faster and providing scans, etc. quicker
• Led to backlash from doctors and BMA, including #ImInWorkJeremy
FOR
• Could improve quality of service
• Consultants able to opt-out of non-emergency weekend work currently
• Extra funding being promised for this
• Some claims that doctors will not work more, just more evenly distributed
AGAINST
• Some studies show little improvement in clinical outcome
• Strain on doctors + services already stretched
• Stephen Hawking accused government of “cherry-picking” evidence to support this idea
• Problem lies in funding
• There is already a sort of 7-day NHS
• Encourages doctors quitting and fewer medical school applicants

7
Q

Junior doctor contract

A

WHAT
• Department of Health started re-writing contracts for junior doctors starting in 2016
• These contracts have an impact on pay and were designed to work along the 7-day NHS proposals
• The government wanted to increase the number of ‘standard hours’ from Monday to Saturday and generally reduce the bonus payed to doctors for working unsociable hours
• BMA disliked the suggestions as it implied that Saturdays were normal working days and it would cause more hours to be worked, leading to tired doctors
• 98% of junior doctors voted in favour of strikes
• Eventually a compromise was reached -> Basic pay increased by 10-11% (although it was meant to go up by 13%), while the night shift pay bonus was reduced from 50% extra to 37% extra. Also, while Saturdays and Sundays are now considered normal working hours, they would get up to 10% extra a year for working at least 7 weekends.
• There was also extra support for doctors who take time off (e.g. doctors on maternity leave)
SEE: Doctor strikes

8
Q

AI in medicine

A

WHAT
• AI is the ability of a machine to make decisions on its own
HOW IT IS BEING USED
• Diagnosis -> From scans, etc.
• Virtual nursing -> Such as wearable tech to remind people to take medication
• Robotic surgery -> Routine procedures -> Shown to reduce complications by up to 5 times
POTENTIAL USES
• Predicting which individuals or groups of individuals are most at risk of illness, so treatment can be targeted
• Processing long-term changes in conditions, which could be missed by a human

9
Q

Bawa-Garba case

A

WHAT
• In 2011, a 6-year old boy was admitted to Leicester Royal Infirmary
• Bawa-Garba was a paediatrics registrar who had just returned from maternity leave
• She made a number of mistakes in communication and treatment -> She did not explicitly ask the consultant to review the patient and did not clearly state that the patient should not be given certain medicine
• When the patient went into cardiac arrest from sepsis, she confused him with another patient who had a Do Not Resuscitate Order and caused his CPR to be stopped for 2 minutes. The boy died.
• Bawa-Garba (and a nurse) were found guilty of manslaughter and given a suspended sentence of 2 years. She was briefly struck off the medical register, which was then overturned, so she only had the 12 month suspension.
MISTAKES
• Chest x-ray that showed an infection was seen 2 and a half hours after it was available. This meant antibiotics were prescribed late. This was because Bawa-Garba was busy.
• Computer system failings meant that blood test results were delivered 5 hours late.
• Mother of patient was not clearly informed that a certain medication had to be stopped, so she administered it.
• Bawa-Garba stopped resuscitation of the boy, confusing him with another with a do not resuscitate order.
LESSONS
• Improving reflective practice
• Looking in computer and technology failures
• Questions about stress and workload of doctors
• Better registration of safety concerns
• Some calls from doctors to just lie about when you’ve made a mistake and never admit it’s your fault -> Reinforcing blame culture

10
Q

Mental health

A

WHAT
• 1 in 4 of us will experience a mental health issue
• First Shadow Minister of Mental Health
• Training for primary and secondary school teachers for identifying mental health issues
IMPROVEMENTS
• Increase in “talking” therapies over drugs, etc.
• 4 new centres for new and expecting mothers
• Specialist mental health in A&E
• More health checks for people with mental health issues

11
Q

Charlie Gard

A

WHAT
• Charlie Gard was a child born with a condition that inhibited the function of his mitochondria
• He was taken to GOSH and placed on a ventilator
• The condition has no cure, but experimental therapies are happening in USA
• After the boy suffered seizures, GOSH determined that his condition was very poor, with brain damage and a lack of feeling and awareness. They discussed and recommended switching to treatment.
• However, the parents did not agree and wanted to take the boy to USA for treatment, which they raised funds for.
• A legal battle ensued, which resulted in the courts deciding that the boy should not receive the treatment since the damage to his brain was irreversible and any success would likely only prolong his suffering.
ISSUES
• Taking up ward space and equipment
• Parental autonomy -> Should the parents be allowed to demand treatment?
• When are experimental treatments for the good of the patient?
• Is prolonging life at all costs a good thing?
• How could the situation be mediated to reach a solution when parents and doctors don’t agree?

12
Q

Alfie Evans

A

WHAT
• Alfie Evans was an infant suffering from an undiagnosed neurodegenerative disease.
• He was placed on life support at Alder Hey hospital, who by 2017 discussed switching off life support, since it was deemed to be “unkind and inhumane”.
• The parents did not agree and so a legal battle ensued. The hospital won and the ventilator was turned off.
ISSUES
• Taking up ward space and equipment
• Parental autonomy -> Should the parents be allowed to demand treatment?
• When are experimental treatments for the good of the patient?
• Is prolonging life at all costs a good thing?
• How could the situation be mediated to reach a solution when parents and doctors don’t agree?

13
Q

Privatisation

A

FOR
• Takes strain off of the NHS
AGAINST
• Private companies may favour profit over quality -> However, the NHS being run on a non-profit basis hasn’t always provided excellent care either
• Private companies may cherry-pick the easiest cases that are most profitable, leaving the NHS with complex, loss-making cases -> However, this may not be a bad thing since the NHS’ expertise is needed to safely deal with tricky cases + tariffs can be adjusted to deal with the costs
• Fragmentation of care -> Patients have to travel to multiple places and there is no central patient records
• Training of doctors will be more difficult if the easier cases are all privatised
• Conflicting interests of doctors -> May own some private businesses which compete with the NHS services

14
Q

Spending

A

Read articles

15
Q

Zika virus

A

WHAT
• The zika virus affects pregnant women, who can pass it onto their foetus, which causes birth defects
• It is spread by mosquito bites or sex
• Not very dangerous for the adult
• Blood or urine test can confirm a zika infection
• There was a significant outbreak in Brazil in 2015, but it ended by late 2016
• No vaccine developed yet
CONTROVERSIES
• “Self-limiting” mosquitos were released that pass on a fatal genes to offspring -> Ethical and ecological concerns
• Government recommendations to delay pregnancy
• Questions about whether abortion is right

16
Q

PrEP

A

WHAT
• Pre-exposure prophylaxis (PrEP)
• Use of antiviral drugs as a preventative measure for patients at high risk of HIV
• Pill taken every day
• 90% protection during sex, 70% for drug users
ISSUES
• Who gets the drugs? -> Certain groups of people get priority with these drugs, which may seem unfair
• Might approve high-risk behaviour
• Doesn’t protect against other STIs

17
Q

Antibiotic resistance

A
PREVENTION
• Funding development of new drugs
• Education -> World Antibiotic Awareness Week
• WHO -> Global action plan on antibiotic resistance
• Preventing infections
• Only using antibiotics when necessary
• Alternating therapy
• Targeting quorum sensing
18
Q

Sepsis

A

WHAT
• When the body’s immune system goes into overdrive as a result of a widespread infection, leading to inflammation all around the body
• This can be dangerous as it disrupts blood flow and can damage tissue
• It can cause death -> 37,000 per year in England
• It is difficult to spot early because the symptoms resemble many different diseases
PREVENTION
• Better training in spotting signs of sepsis
• Reducing workload of staff, so they can be more attentive
• Checklists and algorithms to spot sepsis
• Training primary care specialists to spot sepsis
• Public awareness

19
Q

Winter bed crisis

A

WHAT
• UK has only about 2.6 beds per 1000 capita, while Japan has over 13 per 1000
• Ageing and growing population means that beds can become overfilled and a backlog of filled beds can cause problems over the winter
• Non-urgent surgeries have to be postponed
PREVENTION
• Increasing funding and resources for the NHS
• Improving productivity -> Reducing unnecessary scans, marginally-helpful drugs, etc.
• Tackling general health -> Reducing obesity, etc.

20
Q

Junior doctor strikes

A

FOR
• Long-term improvement in quality of care saves more lives than are lost in the short term
• Most effective way of gaining attention (better than petitions, etc.)
• Doctors are employees and therefore have a right to strike
AGAINST
• Endangers patient lives
• Other public health services can’t strike (e.g. police)
• Influence on public perception of doctors

21
Q

A&E waiting times

A

WHAT
• NHS has set targets to see 95% of patients in A&E within 4 hours
PREVENTION
• Increasing funding and resources for the A&E
• Improving productivity -> Reducing unnecessary scans, marginally-helpful drugs, etc.
• Tackling general health -> Reducing obesity, etc.
• Raising awareness about inappropriate use of services -> e.g. 111 number

22
Q

Postcode lottery

A

WHAT
• The idea that you may receive different treatment for a condition across the country due to the differing policies, funding and drug availability between NHS trusts.
• e.g. IVF funding varies greatly across the country
• This is largely due to CCGs being allowed to decide what to fund most

23
Q

MESH

A

WHAT

• MESH is the main messaging system used in the NHS for communication

24
Q

Extended nurse roles

A

WHAT
• Clinical nurse specialists -> Have a lot of experience in one specialty and can take on some of the some of the duties of the doctor. They can also do some limited prescribing and decisions about acute injuries. Final grade: Nurse consultant
• Nurse managers -> Can manage nurses over a wide region.
• Research nurses

25
Q

NHS funding

A

WHAT
• Planned expenditure for 2018/19 is 127 billion pounds
• Progress in medical technology costs the NHS 10 billion pounds per year
SOLUTIONS
• Increasing taxation
• Using NICE guidelines about QALYS (Quality Adjusted Life Years) to see which drugs are most cost effective
• Efficiency savings e.g. reducing unnecessary antibiotic use
• Preventative medicine

26
Q

NHS Constitution 2011

A

WHAT

• Document that sets outs the objectives of the NHS and the rights and expectations of all parties involved.

27
Q

Health and Social Care Act 2012

A

As a result of this:
• CCGs introduced -> Replace primary care trusts
• Competition between providers introduced
• Passed central day-to-day management of the NHS from the government to NHS England

28
Q

Abortion

A

WHAT
• 1 in 3 women will have an abortion
• Legal until 24th week of pregnancy, unless the mother’s life is at risk
• Issues about whether women should be allowed to take the abortion pill at home

29
Q

Ageing population

A

WHAT
• 18% of the population are over 60
• 15 million people have a chronic disease
SOLUTION
• Social and residential care alongside primary and secondary care
• Preventative medicine
• Public health campaigns

30
Q

Migrant access to healthcare

A

WHAT
• Migrants from outside the EEA must pay 400 pounds with their visa to get free access to NHS services
• EEA citizens with European Health Insurance don’t have to pay
• This is to combat health tourism
• Some things are exempt: A&E services to the point of admission, family planning, mental health
• Some people are exempt: detainees and refugees
• Some conditions are exempt: Infectious diseases and conditions caused by domestic or sexual violence
ISSUES
• Financial - Not providing immediate healthcare can cause the condition to worsen, so it costs the NHS more in the long run
• Public health - Deterring people from going to the doctor can cause certain illnesses to spread more quickly
• Data sharing - Checking everyone for whether they have entitlement to healthcare has data protection issues

31
Q

Obesity

A

WHAT

• 1 in 4 UK adults is obese