Bristol MMI Flashcards
Outline the Assisted Dying bill
A second assisted dying bill was proposed by Rob Marris and it was debated in Parliament in June and September 2015 but it was rejected by the majority of MP’s with a 3:1 against ratio.
What are the arguments for Assisted Dying?
- Autonomy
- The passage of the bill doesn’t mean that people have to choose assisted death - Unjust
- Pressure on family and relatives to assist in something which currently could put them in prison for 14 years because these patients are unable to seek professional medical care
What are the arguments against Assisted Dying?
- Autonomy
pressured to die
prevent persuasion of elderly, relatively to be cohersed into ending their life
does it elevate private benefit over public good? - Non-maleficence
Poison is not pleasant
- Is it a dignified end? - Pandora’s box that will fundamentally change who we are and how we link to the medical society
- changes the relationship between the doctor and their patient, it would not just legitimise suicide, but promote the participation of others in it.
Conclusion on Assisted Dying
The law as it stands is a cast iron guarantee that life is not to be taken in any circumstances. Assisting someone to die is a form of killing so in a sense this would be doing harm.
Outline Sugar Tax
In October a report by Public Health England recommended a tax of between 10 and 20% on high-sugar products as one of the measures needed to achieve a “meaningful” reduction in sugar consumption.
What are the arguments for Sugar Tax?
- A new study in the British Medical Journal said Mexico’s sugary drinks tax led to a 12% reduction in sales
- Obesity crisis
type 2 diabetes -> cardiovascular disease -> potentially hormone related cancer
It’s not just the well-being of people in this country and our children. But it’s also the sustainability of the NHS itself
obesity is a huge burden on the NHS -> 6.3 bill - It is expected the NHS levy, which would initially only apply to sugary drinks, could raise £20m-£40m a year
It is hoped the tax would discourage staff, patients and visitors from buying sugary items, while the money raised would be used to improve the health of the NHS’s large workforce
What are the arguments against sugar tax?
- Autonomy
Food and drink industry to develop more alternative products that do not have high sugar levels - You have to evaluate whether or not there is a causal relationship.
Carbohydrates and fats can equally lead to obesity but we can’t place a tax on all food surely - Would this tax discriminate against the poor?
Time trend study 2002 - 2012 -> Cambridge and East Anglia
Healthy foods 3x more expensive on average per calorie than ‘junk food’ in 2012
Conclusion on Sugar Tax
I support the NHS levy on sugary drinks but I think that in order for a tax to be implemented by the government on all high sugar products, the price of healthy foods needs to decrease in order to prevent essentially taxing of the poor.
Outline Junior Doctors Contract
Jeremy Hunt is proposing that a new contract is imposed on junior doctors which would increase their working hours to provide a better 7 day service of the NHS which would decrease their overall pay.
Arguments for the contract
- ‘Weekend Effect’
Hospital patients admitted at weekends ‘15% more likely to die’
implementation of 7 day working week could increase staffing of junior doctors during the weekends
41% of patients needing life-or-death emergency bowel surgery after midnight had both a consultant surgeon and a consultant anaesthetist present at their operation - The Government says the new deal would have an absolute limit of 72 hours in any week, lower than the 91 hours that the current arrangements allow.
No junior doctor will have to work more than four nights in a row – down from the current week of nights - or five long day shifts in a row, compared to the existing seven long day shifts, the Department of Health says
- 13.5% basic pay rise
Hunt has argued that just 1% of doctors would lose pay and those would be doctors working too many hours already - Proposes “recruitment and retention premia” for specialities that are hard to recruit to, like Accident and Emergency, general practice and psychiatry
- The new system would mean doctors get paid more for “unsocial” hours - but would be a lower proportion of overall pay.
Arguments Against
- The deaths may not be necessarily caused by under staffing of junior doctors.
There’s no causal relationship, it’s more likely to be linked to increase recreational activities during the weekend eg. alcohol or drug consumption - Working hours
- Wages of doctors
Many doctors facing a pay cut
7.89 an hour
Lidl and Morrisons staff 8.20 an hour - Specialties
Psychiatry on call less than minimum wage due to non-resident on-call availability allowance
Plan to remit category 2 fees
A & E no flexible pay premia + extension of plain time - BMA five pay points
- > junior doctors would earn the same amount as current training
Would increasing working hours decrease the quality of patient care?
As it stands the contract would require junior doctors to work 56 hours a week. 8 hours a day
reduce the number of breaks during shifts down to just 20 minutes every six hours. In practice, this could mean that a doctor working an eleven hour shift will only get a single 20 minute break
less time for training, better trained doctors -> better service for patients
Currently hospitals are monitored, with financial penalties if doctors are regularly working longer hours than the European Working Time Directive allows.
removing accountability of hospitals to ensure junior doctors are working safe hours
Conclusion for Junior Doctor issue
Contract could be better negotiated, should not be imposed. But since it’s being imposed on junior doctors, Jeremy Hunt should sit down and discuss the terms with junior doctors. Whilst, he does have good intentions in terms of providing better patient care in unsocial hours, the new contract takes away a way of insuring that doctors are working safe hours which could decrease the quality of patient care. This means that although there would be an 13% basic pay rise, many doctors could be facing a pay cut and will be earning disproportionately lower wages than their peers in professions which didn’t require as many years of training. Striking may not be the most effective method of negotiating with Hunt, backfire and cause a loss of sympathy.
What is Bed Blocking?
Bed-blockers are a derogatory term to describe patients who are occupying a hospital bed that they don’t strictly need In almost all cases, it isn’t their fault; rather, their discharge will have been delayed because the NHS hasn’t completed the necessary paperwork or the local authority hasn’t been able to organise the next stage of their care. The number of days health managers are forced to keep patients in hospital because they cannot be transferred into the community has risen by nearly 20 per cent in a year.
Causes of Bed Blocking
- Social care crisis
- Labour blamed the delays and bed-blocking on cuts to social care budgets, which have been reduced by £3.5bn since 2010. They argued it was a false economy to cut social care because it meant more elderly people were being admitted to hospital instead of being cared for at home. In turn, the same group of patients were being transferred back home less quickly because of reductions in social care services.
- With adult social care support reduced, the number of over-90s rushed to A&E by ambulance has increased by half since 2010
