Current Issues and News Flashcards
https://www.themedicportal.com/application-guide/the-nhs/challenges-facing-the-nhs/
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https://www.themedicportal.com/nhs-hot-topics-private-healthcare-and-privatisation/
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https://www.themedicportal.com/application-guide/medical-school-interview/nhs-hot-topics-2018-19/
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What are some challenges facing the NHS right now?
- 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
Brexit
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
7-day NHS
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
Junior doctor contract
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
AI in medicine
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
Bawa-Garba case
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
Mental health
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
Charlie Gard
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?
Alfie Evans
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?
Privatisation
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
Spending
Read articles
Zika virus
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
