general

Question 1

What are the 4 pillars of medical ethics?

Answer 1

Beneficence- duty to ‘do good’
-goes beyond doing no harm, encourages to actively help
-should update skills and knowledge
-consider patient’s individual needs
-in line w patient’s expectations
-so, req patient centred care

Non-maleficence- duty to do no harm
-should not cause harm by actions or neglect
-if treatment causes more harm than good, shouldn’t be considered
-should consider patient safety and comfort

Autonomy- respect patient’s rights to make decisions about their healthcare
-cannot impose treatments of interventions w/out informed consent
-instead, enable patients to make informed decisions
-decisions should be free from coercion and pressure
-only exception is when patient deemed unable to make autonomous decision

Justice- to treat all people equally and equitably under law and in society
-compatible w law, patient’s rights, fair and balanced
-ensure no one’s fairly disadvantaged
-determines how resources are split, complicated by limited funds

Question 2

What is utilitarianism?

Answer 2

Actions that cause the most happiness and pleasure for the most amount of people are ethical

Question 3

What is deontology?

Answer 3

States actions can be determined as right or wrong depending on if they follow a set of rules, rather than the consequence of the action

-holding drs to rigid prof standards and guidelines (GMC)

Question 4

What is consequentialism

Answer 4

‘Ends justify the means’

Question 5

What is holistic/patient-centred care?

Answer 5

Has 5 key principles:

-personalised care: Focus on individual HUMAN patient (face2face consultation)

-empathy: build human connection and better understanding

-informed consent: seek patient’s voluntary, informed and understood consent (respects autonomy and protects from medical paternalism)

-continuity of care: prefer to see a doctor they already know and trust, easier for dr to identify on changes, improved healthcare outcome

-patients as partners in care: patients enabled and educated to be involved in decisions affecting their own care

Question 6

what is capacity

Answer 6

-capacity is ability to give consent

Requires:
-understanding information
-retain information
-weigh up to make a decision
-communicate decision

-Gillick competency - used to decide whether child is mature enough to make decisions

Question 7

What is Gillick competency?

Answer 7

Used to decide whether child is mature enough to make decisions ab their own health (under 16)
If patient is gillick competent parents can say no but will still go thru

Question 8

What is consent?

Answer 8

-when patient gives permission before receiving medical treatments
-voluntary, informed, patient has capacity
-given in 2 ways: verbally, written
-consent is not needed in: emergencies, patient has severe mental health conditions, poses a wider risk

-implied consent in direct care - patient is aware that a Doctor will share information about them to other individuals in the healthcare team to provide the patient with the best possible care

Question 9

What is confidentiality?

Answer 9

-key to building strong doctor-patient relations
-patients under-report symptoms/ avoid seeking med help if they think info isn’t confidential
-sometimes required to break confidentiality: severe harm to themselves or others

Question 10

What does the GMC teach

Answer 10

-General medical council - regulatory body for medical professionals in the UK
-Oversees education, training, practise of doctors
-Ensure standards are met to maintain patient safety and public trust in the medical profession

-Good medical practice, published by the GMC, outlines principles doctors must follow:

-Patient centred care
-Maintaining professional competence
-Effective communication
-Ethics and accountability
-Continuous professional development

-Important because
-ensures patient safety and wellbeing
-provides ethical framework
-encourages accountability
-maintains public trust in the profession
-guides professional devp

Question 11

What are the NHS values

Answer 11

-Working together for patients
-Respects and dignity
-Commitment to quality of care
-Compassion
-Improving lives
-Everyone counts

Question 12

What are the Fraser guidelines?

Answer 12

Outline the scenario in which advice can be given to a child about contraception and sexual health without parental consent

Question 13

What are virtue ethics

Answer 13

Aim to act as virtuous person, rather than according to guidelines or according to results

4 cardinal virtues
prudence - using reason and intellect to decide what’s right and wrong
justice - treating everyone fairly
fortitude - being courageous in face of danger, acting in high pressure emergency situation
temperance - restraint of personal wants, putting patient desires above and team before ourself

Question 14

Empathy

Answer 14

understanding and sharing a patient’s feelings

cognitive (rather than emotional) empathy

Question 15

What are each uni’s different teaching style

Answer 15

-Keele and BARTs use problem-based learning
-Cardiff uses case-based learning
-Leicester is more integrated????

Question 16

What is euthanasia?
How can you categorise it?

Answer 16

Euthanasia - ending a patients life who is suffering from an incurable/painful disease OR in a irreversible coma

Active - acting person deliberately intervenes to end someone’s life
Passive - person causes death by withholding/withdrawing treatment necessary to maintain life

Voluntary - carried out at request of person who dies
Involuntary - patient wants to live but killed anyways (manslaughter/murder)

ILLEGAL in the UK - life imprisonment
Passive euthanasia seen as part of palliative care, tech not regarded as euthanasia

-patients go to dignitas in Switzerland to be euthanised

Question 17

What is assisted suicide?

Answer 17

In this, physician gives patient the means to take lethal medication themselves

Question 18

What is assisted dying

Answer 18

Sub term of assisted suicide
Only used in the context of a patient who’s already dying

Question 19

History and legalities of euthanasia/assisted dying? In UK, in other countries

Answer 19

Legalities:
-2015: House of Commons rejected bill to allow those in last 6 months be prescribed med to administer themselves
-2018: UK Supreme Court ruled legal permission no longer needed to withdraw patients in permanent veg state (BMA and RCP published guidance)
-2019: Paul Lamb living with chronic pain renewed but for right to die
-2019: Mavis Eccleston cleared of murder and manslaughter after giving husband prescription med he needed to overdose
-2019: Paul Newby lost High court case challenging assisted dying
-2020: joint enquiry into assisted dying
-2021: BMA adopted neutral stance on euthanasia

CURRENT:
Introduction of Terminally Ill adults (End of Life) Bill
Proposes giving terminally ill adults right to chose to end own life
-Must be over 18
-Have mental capacity, clear, settled, informed wish, no coercion or pressure
-expected to die within 6 months
-witnessed and signed declarations
-satisfy 2 doctors
-High court judge would have to rule
-must be administered by patient themselves
MPs voted in favour of this bill, passing first stage in the Commons

Euthanasia legal in Netherlands, Colombia, Luxembourg, Belgium, Canada, Spain, New Zealand and some parts of Australia
Assisted suicide legal in certain areas of the US

Question 20

Arguments for and against euthanasia

Answer 20

FOR:
-no matter level of palliative care, always some patients whose illness causes intolerable suffering
-autonomy: patients have right to chose to end life inadequate symptom control
-many patients currently travel to Switz Dignitas
-inc public support in assisted dying, democracy, moral norms change
-do as you wish as long as its not harming others?
-safer deaths
-clearer end of life legal framework (double effect- pain relief may shorten life)
-Death with Dignity in US state Oregon, no inc deaths or poorer n of end of life care

AGAINST:
-non maleficence - do no harm (both for in against, killing vs suffering)
-worry that law may extend to children or vulnerable groups
-risk of sending out message that that falls short of certain conditions isnt worth preserving
-patients have autonomy, but doctors have right to reject treatment
-govt in better position to determine affect of laws on country, regardless of mass view
-vulnerable people may feel pressure, safeguards won’t be able to remove this pressure

-do the pros outweigh the cons

Question 21

What is palliative care?

Answer 21

Improves quality of life of patients experiencing life-limiting illnesses
Works to manage pain and other distressing symptoms

Question 22

What is end of life care

Answer 22

Care surrounding last year of your life

Question 23

What is abortion

Answer 23

-Medical process of ending a human pregnancy so it doesn’t culminate in the birth of a baby
-Can be through medication or surgical procedure

-Legal under The Abortion Act
-Can only be carried out in first 24 weeks
-2 doctors must decide it’s less damaging to the patients mental and physical health

-Legalised to take second pill at home to prevent risk of miscarrying on journey home

Question 24

Arguments for and against abortion

Answer 24

FOR
-almost all done within first 3 months, foetus cannot exist independently outside womb, so not living organism and not murder
-fertilised eggs in IVF thrown away or destroyed if not implanted but that’s not murder
-in case of rape, forcing women to have child may be more damaging
-keeping it legal prevents deaths and complications from secret abortions
-abortion may be necessary to keep woman alive

AGAINST
-human life begins at conception making abortion murder
-child could be adopted and should not be punished by being aborted
-abortions can cause psychological distress
-child could have been very important to society

Question 25

Challenges faced by the NHS

Answer 25

Ambulances
Backlogs
Care
Doctors & Dentists

Question 26

Challenge of ambulances in NHS

Answer 26

-Measure of performance is response times

-4 categories of ambulances responses:
Immediate response to life threatening condition (under 7 mins to reach)
Serious condition requiring urgent transport/treatment (under 18 mins to reach)
Urgent problem, req transport and treatment in acute setting (2hrs)
Non-urgent problem, req transportation (3hrs)

-Ambulance wait times are significantly higher, especially category 2 BUT even category 1… these are serious and req timely treatment
-Impacts patient safety

(BHA article: avg waits for heart attacks and strokes rise to 42 mins, still missing increased waiting time targets, worst region was East Midlands at 1hr, so important for heart attacks and strokes, each min counts, risk of permanent brain/heart damage)

Reasons:
-unprecedented levels of demand post-Covid
-post 2010 cuts to community services have inc pressure on emergency services, treating w more acute issues
-shortage of paramedics, left to find better work-life balance
-A&E wait times, emergency depts overcrowded, slows down ambulance crews, must wait with patients until space becomes available

Attempts to solve:
-Govt allocated 150 mil, 3% pay rise to incentivise retention

Question 27

Challenge of backlog on NHS

Answer 27

-Due to decision to suspend elective treatment during covid 19 pandemic
-initial drop in waiting lists but steep increase in 2020

-Large list, people have been millions waiting for 18 weeks, some for over a year
-Much greater than pre pandemic levels
-Hidden backlog (people who haven’t put themselves on waiting list due to backlog/had appts cancelled)

-Waiting times in A and E severely increased, taking more time to treat emergency patients

Cancer waiting times
Target time between referral from GP to consultant is 2 weeks (90%)
However is significantly less

Blamed on
-COVID pandemic
-severity of conditions patients are presenting with
-longer ambulance wait times
-Changes in wider community health provision

Question 28

Challenges of care in the NHS

Answer 28

-Care sector includes all roles that support people who require specialised assistance to live their daily lives
-important in ensuring people’s physical/mental supported before GP/emergency

Challenges:
-Unfilled vacancies
Fewer members of staff, support dec
Manifest as inc emergency admissions
Also, non-prof care - people become unpaid carers

Causes:
-Avg pay of care sector worker did not inc relative to national living wage inc (2019-21)
-Govt inc the following year, but not sufficient

-Brexit meant EU workers could not work in care sector, creating vacancies
-Then reversed

Question 29

Challenges of doctors and dentists in NHS

Answer 29

-progress in raising numbers of med students, recruiting nurses
-less progress in ensuring access to GP appointments and dentists

-many patients don’t see their GP in a timely manner
-inc patients in emergency wards

-even more severe in dental practices

Question 30

DNACPR

Answer 30

do not attempt cardiopulmonary resuscitation

Question 31

LPA

Answer 31

Lasting power of attorney
-appoints a person to make decisions when you cannot

Question 32

Who can you escalate concerns to within a hospital?

Question 33

What are GP and primary care issues and solutions?

Answer 33

Gp and primary care issues
-GP shortages
-inc demand as life expectancy rises
-recruitment issues
-practices are closing ?
-unsafe patient levels (gps working too many hours and handling too many patients)
-long waits for appointments
-unnecessary appointments waste time
-public satisfaction is low

Solutions for gp services and primary care
-need to hire more gps
-medical schools trying to correct misconceptions about GP role
-NHS schemes to incentivise foundation year doctors to become GPs
-golden hello one off payment for gps coming to work in certain areas needing gps
-international recruitment(st)
-funding to help gps woe, as primary care network
-digital solutions

Question 34

What is organ donation

Answer 34

Act of giving an organ to someone who is in need of a transplant

LEGAL
-soft opt out in the UK
-families of potential donors have the right to final say

Opt in vs opt out

-potential to prioritise donors in organ transplant list in opt in system

Question 35

What are challenges with organ donation?

Answer 35

-Demand is higher than supply
-Creating waiting list for organ transplant
-People dying before receiving transplant
-Only small proportion of deaths leave viable organs for organ donation
-Tissue type and blood group match req too
-BAME experience longer waiting times because there is a lock of organs from BAME doners

Question 36

What is the A&E crisis? Reasons? Measures? Solutions?

Answer 36

3 types of A&E depts
-type 1: major emergency consultant-led depts providing 24 hour service
-type 2 depts: dedicated to specific specialties
-type 3 depts: treat minor injuries + illnesses, including walk in centres + minor injuries units

A&E wait times
-struggle to achieve 4 hr standard
-Financial and staffing pressures

Why?
-Rising A&E attendance
-Fewer hospital beds: leads to delays in diagnosis and treatment for patients waiting
-Age of patients: aging population, comorbidities
-Unnecessary A&E attendance
-Delayed discharges: may need additional support before discharge
-Staffing shortages: inc workload, burnout, reduce efficiency

Scrap 4hr target?
-useful for overall performance
-not to be focused on, doesn’t provide full pic
-safety, quality of care important, patient experience

Can use
-number of re-attendances within seven days of their first attendance
-waiting time to see a clinician
-Care Quality Commission (CQC) rating of core hospital service
-Patient satisfaction surveys

Solutions
-assemble GPs, A&E staff, urgent care teams and pharmacists to create new emergency and urgent care hubs
-investing as much money as possible in primary care

Question 37

Why have junior doctors gone on strike?

Answer 37

-Pay restorations of junior doctor salaries
-Inflation increases expenses
-Drs don’t attend schedules shifts or emergency cover
-Stopped, agreed to 22% pay rise over next 2 yrs
-occurred previously over junior dr contract too

Question 38

How does strikes affect patients?

Answer 38

Negative:
-Fewer doctors present in AE so longer emergency wait times, endanger patient safety
-Cancellation of appointments due to understaffing
-Fewer doctors on wards, inc stress level, errors
-Deterioration of doctor-patient relationship

Positive:
-Increase in doctor salary means doctors are less stressed, overwhelmed, better patient care
-improved working conditions reduce physical and emotional pressure, better patient outcomes

Question 39

Ethical reasons for and against strike?

Answer 39

Against:
-non maleficence, broken by understaffing due to strikes
-affects doctor patient relationship
-beneficence not honoured as big moral to delay patients treatments when avoidable
-creates cost as you have to pay consultant salary to consultants filling in junior doctor roles, money could’ve gone elsewhere
-strikes put extra stress and pressure on multidisciplinary team

For:
-doctors are human beings so shouldn’t have to accept poor working conditions
-better pay and working conditions will improve quality of life of doctors, making them better clinicians
-literature shows mortality of patients remains at same or lower levels during strike action
-full walk outs seem negligent but it needs to be impactful to be effective
-understaffing crisis could get worse as many doctors looking to leave country, lower quality of life for patients

Question 40

What is the NHS?
How is the NHS funded?

Answer 40

System that UK uses to provide healthcare to their citizens, consisting of 4 semi independent systems (England, Scotland, Wales, NI) in mid 1940s

Funded by:
-general taxation
-National Insurance contributions
-approx 1% from services such as prescriptions/dental treatment

Question 41

What are key founding principles of the NHS?
What are current principles of the NHS?

Answer 41

Founding principles of NHS:
-Free
-Financed from general taxation
-Available to all

Current 7 key principles of the NHS:
-comprehensive service available to all
-access to NHS services based on clinical need not individuals ability to pay
-aspires to highest standards of excellence and professionalism
-aspires to put patients at heart of everything it does
-works across organisational boundaries
-comitted to providing best value for tax payers money
-accountable to public, communities and patients that it serves

Question 42

What was healthcare like before the NHS?

Answer 42

1911 - labour PM introduced NI act to partially fund healthcare for working people (workers had medical care, retirement and unemployment benefits)
Medicines paid
Women and children less likely to be legally employed, didn’t have free medical care

Question 43

How is the NHS changing?

Answer 43

-When set up, focused on treating individual illnesses
-Now people live longer, suffer from multiple conditions
-GPs come together to form primary care networks in ‘neighbourhoods’ - sharing resources, coming together with other organisations, means they can provide wider range of services
-Health and care organisations working together in larger areas ‘places’ work together to understand and met local health needs
-Laws changed to make it easier for working together
-Organisations come together to form Integrated Care Systems (partnerships of health and care systems that plan and pay for health and care services)
-ICS made up of integrated care boards (decide how NHS budget for are is spent and develop plan) and integrated care partnerships (bring NHS altogether with key partners eg local authorities for develop strategy to enable ICS to improve health and well being)
-NHS trusts coming together to form provider collaboratives (bring together hospitals, mental health services and community services)

-Move healthcare settings from hospitals to community
-Inc number of NHS staff, utilising digital tech, data, research
-Prioritise preventative measures

Question 44

What does department of health and social care do in uk?

Answer 44

Secretary is Wes Streeting

-govt responsible for funding and coming up with policies for healthcare in the UK

Question 45

What is the structure of the NHS now?

Answer 45

-State-run healthcare system so govt ultimately have control
-PM and Health Minister (Wes Streeting)
-Funded by general taxation, National Insurance contributions, approx 1% from services such as prescriptions/dental treatment
-Level of NHS funding set by central government
-NHS mandate released
-NHS England commissions services on national level
-Money passed to Integrated Care Systems who spend on comissioning healthcare services from healthcare providers
BIG CHANGE: both commission majority services of NHS, ICS consists of integrated care board and partnership, ICB responsible for comissioning NHS service has wider range of members and is responsible for health outcomes and performances, ICP promote integration in NHS, local govt, by producing integrated care strategy for area
-Healthcare provider: Hospitals, GPS, pharmacists, community nurses (provide healthcare)
-Compete for contracts from ICB
-Primary care networks: aim to enable more integrated primary care at neighbourhood and place level, usually led by GP

Question 46

Who inspects nhs?

Answer 46

Care Quality Commission

Question 47

What is the privatisation of the NHS and some impacts

Answer 47

-Removal of public ownership of the NHS, involvement of private organisations
-NHS would have to provide contracts to various private sectors to carry out individual services

-opportunity for inc pay
-more fragmented healthcare
-affect medical school teaching as hospital care provided for by dif sectors

Question 48

arguments for and against privatisation of NHS

Answer 48

FOR
-aids NHS waiting lists
-reduces wait times
-inc in income, more incentive to continue to work in the uk
-patients have free will to chose dif treatments
-reduces patients visiting dr unnecessarily
-patients still contribute to nhs thru NI

AGAINST
-affects justice, not wealthy wont be able to access private care
-negative impact on those requiring long period of care, expensive
-resources may not be shared equally, certain patients may be prioritised
-financial focus rather than patient

Question 49

What is AI and how is it being used in med?

Answer 49

Artificial intelligence is the ability of a computer/machine to perform actions that require intelligence

USED
-accurately diagnose disease from medical imaging scans and microscope slides (cancer detected earlier, likelihood of fertilised embryo leading to pregnancy in IVF)
-radiotherapy using AI to create individualised dosage according to tumour
-robotic arm surgery, reducing risk of surgical complications
-information services

PRACTICAL USES
-earlier diagnosis thru pattern recognition
-data collection and storage

ISSUES:
-confidentiality, which data is being used? is it being safely stored?

Question 50

levels of care

Answer 50

-primary care: first point of contact (gps, community pharmacies, nurses)
-secondary care: specialist care typically in hospitals after referral
-tertiary care: advanced, specialised treatments (highly complex surgeries/treatments for rare conditions)

Question 51

NHS current challenges? + solutions

Answer 51

-insufficient funding
funding allocated has not increased in same proportion of rising demand
strain on resources, longer wait times, limited access to certain treatments, dif to maintain high qual car, lack of investment in improvement

-staff shortages
dr, nurses, allied health professionals
pressure on existing work force, inc work load, burnout, compromised patient care, longer wait time

-backlog
covid19 exacerbated pre-existing backlog
accumulation of patients who have experienced delays in receiving necessary care due to resource constraints
impacts patient outcomes, increases waiting times, adds strain

-ageing population
higher prevalence of chronic conditions and complex healthcare needs
inc demands on healthcare services

-evolving healthcare need
driven by factors
eg advancements in med tech, changes in disease prevalence, shifting societal expectations

CAUSED STRIKES

SOLUTIONS

-inc govt funding to NHS to meet demand
-new funding models?
-allocate funds strategically

-inc recruitment and training (inc medical school places)
-invest, promote, incentivise
-improve working conditions
-utilise tech, inc efficiency, alleviate pressure

-inc capacity, invest in additional resources eg, staff, equipment, facilities
-prioritise urgent cases, ensure timely care
-collab with private providers, add capacity

-integrated care models, ringing tg social and health care services to provide better care for old
-invest in geriatric services, palliative care and end of life care
-promote healthy ageing to red burden of chronic diseases

-embrace digital health tech to enhance efficiency, improve access
-focus on preventative care, dec future burden
-foster collab and innovation

Question 52

Jim the Horse Tetanus Scandal

Answer 52

-milk wagon horse who had symptoms of tetanus
-eventually euthanised
-was used to create serums containing the diphtheria antitoxin
-administered to patients who were susceptible to the diphtheria infection
-led to the death of a girl in Missouri
-serum was contaminated with tetanus
-batch of serum was not tested before use
-led to the death of 13 children
-Jim should have been immunised against tetanus

-scandal had implications for patient safety and trust in the healthcare system
-affected the role of regulatory bodies in patient care
-lack of orderly procedures and oversight, patient safety was severely compromised, and the public had lost trust in the healthcare system.

-scandal brought into consideration various ethical issues
-such as beneficence and non-maleficence, for both Jim the Horse and children involved

Question 53

NHS whistleblowing

Answer 53

-raising concerns within NHS
-often around unsafe staffing levels, systems that do not work and may harm patients (eg unsafe training)
-sometimes about staff member

-usually refers to taking concerns to an official channel, rather than discussing with colleagues directly
-workplace raising concerns guidelines to follow
-official channels to raise concerns

-important to prevent harm to patients and staff
-make changes
-duty GMC to prevent harm

-can also be challenging
-stand up to colleagues/managers who have a lot of power
-WB should not face consequences in the workplace, but many have in NHS

-speak to people involved, to supervisor/senior, to external organisations

Lucy Letby case

Question 54

UK’s ageing population

Answer 54

-refers to age demographics of a country, large number of older people

-positive affect of good healthcare
-higher LE, people living longer, larger pop at older age
-inc burden on healthcare

-older pop, more chronic diseases (heart disease, Type 2 diabetes, arthritis, Alzheimer’s)
-complex social needs, require additional support with daily activities
-dementia
-cost for support w daily activities can be high and needs to be partially funded by patients

-cuts in social care led to inc A&E admissions for older people
inc demand on alrdy struggling services
-inadequate social care leave eldery people more vulnerable to infections, falls, dehydration
-can take weeks for discharge so bed blocking
-certain areas more vulnerable, eg retirement towns (rural/coastal)

-healthy life expectancy much lower than avg LE
-hle is avg number of years person will spend in good health
-longer period of time w major health concern
-govt ambition to inc HLE by 5yrs by 2035
-inc public health education and support for smoking, better nutrition, improved physical health and fitness
-reduce risk factors for conditions eg heart disease and dementia
-improved support for people living with LT disabilities

Question 55

What are the Francis reports

Answer 55

Robert Francis is Barrister, medical law
Led public enquiry into poot care at Mid Staffordshire NHS Foundation Trust 2005-9

Healthcare Commission report exposed poor treatment, high mortality rates

Recurring problems
-call bells unanswered
-patients left lying is their own urine/excrement
-food/drink left out of reach
-patient falls being concealed from relatives
-too few consultants/nurses
-poor communication between staff and relatives

-chronic understaffing, mismanagement, trust’s focus on targets rather than patient care
-barriers to raising concerns, bullying, systemic issues affecting staff and care quality.

Recommendations:
-adequate staffing levels and skill mix
-protection of whistle blowers
-eradication of blame culture
-improved training and regulation for HCA, nurses

GMC- Enhanced safety, education, information sharing
Government- actions to improve care (eg transparency)
NICE- Developed staffing guidelines to ensure safety

Question 56

vaccinations

Answer 56

-small amount of weakened/dead version of pathogen
-immune systems develops pathogen and memory for future

-herd immunity: if enough people immune thru vaccine, those w/out protected
-mass protection: prevent millions of deaths

-nhs offers schedule of free vaccines
-13 childhood vaccines
-vaccines offers in schools

-covid 19 vaccine (pfizer)

-antivax
-MMR vaccines

-less uptake of vaccines
-fake news, negative messages
-lack of appreciation of importance

-nhs LT plan to combat this

Question 57

Bawa-Garba case

Answer 57

• Six-year-old Jack Adcock was admitted to a hospital with a serious condition and later died after his health deteriorated
• Dr. Hadiza Bawa-Garba, the junior doctor responsible for his care, made several mistakes, including delayed treatment and incorrect decisions during resuscitation
• The hospital faced systemic issues, including understaffing, poor communication, and technical failures that contributed to the errors
• Dr. Bawa-Garba was convicted of gross negligence manslaughter, leading to legal proceedings about her fitness to practice
• After multiple appeals, she was initially suspended, but later returned to work with conditions and was fully reinstated in her practice
• The case brought attention to the challenges within the NHS, such as the pressure on junior doctors and the need for a more supportive healthcare system

Question 58

BAME NHS

Answer 58

staff:
-unequal representation amongst board members
-recruitment barriers
-less likely to be supported
-likelier discrimination

how nhs is addressing
-NHS People Plan has action points to increase BAME representation
-make the NHS more reflective of the patient population that it serves
-engage w staff and networks so BAME staff can be heard and involved

-need to address structural racism and unconscious biases

Patients
-more likely to die during childbirth
-detrimental health outcomes (socioeconomic)

COVID19
-disproportionate mortality and morbidity

How is NHS addressing?
-publishing guidance for NHS organizations to consider ethnicity and age in risk assessments and work adjustments
-creating tailored health and wellbeing support for BAME staff
-funding research projects to investigate the links between COVID-19 and ethnicity

Question 59

COVID-19

Answer 59

-1st cases of covid 19 confirmed on January 31, 2020
-potentially earlier undetected cases

MORE CASES/fatalities
-greater economic disparities
-weaker absent leaders

-UK variants and others

GOVT RESPONSES
-LOCKDOWN
1st: only leave for food, med, exercise, look after vulnerable
2nd: schools, colleges, universities were allowed to stay open
3rd: everything closed, public exams cancelled

-Herd immunity

Question 60

Public health measures

Answer 60

devped countries - most deaths caused by non-communicable diseases ESP CVD

-growing evidence that lifestyle factors inc risk of certain diseases

-high obesity rates, esp childhood obesity
-sugar tax
-education

Sugar tax 2018
-inforced tax on drinks w certain amounts of sugar
-govt said this tax would fund school sports and breakfast clubs but didnt happen
-purchasing remained same, companies reformulated to less sugar

Childhood obesity
-sedentary lifestyle, junk food
-risk factor
-causes major health problem in future
-local councils given money to combat
-investment in giving children opportunities to exercise
-education

COVID19
-better health campaign
-banning unhealthy food ads before 9pm
-ending buy1get1 for unhealthy
-ban on items placed in prominent locations
-calorie labelling on menus
-expansion on weight management support

Question 61

Mental health

Answer 61

-important issue
-increasing
-especially in children and young adults
-perinatal

-covid19 worsened

-nhs allocated extra funding for ED services

-poor access to mental health care

-money allocated for mental health support for nhs staff

-money been allocated

Question 62

Antibiotic resistance

Answer 62

-antibiotic resistance occurs when bacteria evolve to resist the effects of drugs
-making infections harder to treat

-in 2050, antibiotic resistance could cause 10 million deaths annually

CAUSE
-overprescribing antibiotics
-inappropriate antibiotic prescriptions
-patients stop/misuse bacteria

IMPLICATIONS
-infections resistant to drugs inc
-dr have to prescribe multiple antibiotics

SOL
-prescribing more cautiously
minimise infections
-educate
-new drug devp, therapies
-AI usage potential to identify what antibiotic to use

Question 63

Brexit and NHS

Answer 63

implications on staffing, funding and scientific research

-false inc funding claims

-sig loss of EU staff working in NHS
-currency depreciation, immigration restrictions led to inc loss of workers

-uk stockpiled drugs before brexit, pandemic depleted these reserves

-uk lost guaranteed access to EU research grants

-EU students no longer benefit from the same tuition fees or student loans as UK students
-prevents students coming or students gaining education in EU

Question 64

HIV and PrEP

Answer 64

-human immunodeficiency virus
-PrEP medicine taken by HIV negative person before sexual intercourse to prevent transmission of HIV
-antiretroviral drug

-one tablet taken every day/other options
-very effective for daily use

-readily available by NHS

-req regular testing, potential side effects, requires daily consumption to be effective
-does not protect against other STIs
-If someone unknowingly becomes HIV-positive while on PrEP, it could lead to drug-resistant HIV strains

antiretroviral therapy for those positive
prevents from progressing to AIDS
U=U - undetectable, untransmittable

Question 65

Medicinal cannabis

Answer 65

-legal change: from nov 2018, cannabis derived med legalised in UK for exceptional cases

-children w severe epilepsy
-adults w chemotherapy induces vomitting
-adults w muscle stiffness from multiple sclerosis

-slow implementation
-requirement of more sufficient research

Question 66

Diabetes and ozempic

Answer 66

-ozempic helps control blood sugar by stim insulin secretion, lowering glucagon levels, also aids in weight loss
-initially for type 2 diabetes
-gained popularity as a weight loss drug
-demand outweighs supply

-popularity of ozempic driven by celebrities and social media

Question 67

NHS winter pressures

Answer 67

-high demand for urgent and emergency care services
-patients need quick attention for conditions(respiratory infections, flu)

-staff shortages exacerbated by illness, staff burnout

-inc hospital admissions due to winter-related illnesses lead to overcrowded emergency departments

-long waiting times (emergency dept) are common during peak winter months​

SOLUTIONS
-vaccination campaigns targeting flu, COVID-19, RSV to reduce the burden

-improve patient flow with initiatives to streamline hospital discharges, prioritize urgent care, and maintain consistent care standards​

-expand community care and mobile health services for older and vulnerable populations to prevent unnecessary hospital admissions​

-inc oversight and support for local NHS trusts, including deploying clinical experts to areas struggling with demand

Question 68

NHS LT plan

Answer 68

-outlines the direction for the NHS in England over the next decade
-aims to improve care, address health inequalities, and make services more sustainable

FOCUS

-preventing illness, tackling lifestyle factors/risk factors
-inc investment in primary care
-earlier diagnosis thru screening, faster access to cancer treatments

-expansion of mental health services
-integration of mental health and other social health, into primary care

-using data, AI and tech to streamline processes and improve patient outcomes

-recruiting and retaining workforce, more diverse, more support

-reduce wait times

-create sustainable funding
-greener

-more integrated

Question 69

Quad-demic reform

Answer 69

public health challenges faced due to four respiratory illnesse
-COVID-19
-influenza
-respiratory syncytial virus (RSV)
-norovirus

-widespread vaccination campaigns
-improving same day emergency care
-investing to be able to cope with higher patient numbers
-preventative care
-more efficient care