* Hot topics Flashcards

Question

Medical licensing assessment

Answer 1

- applied knowledge test that is computer-based, and a clinical and professional skills assessment. - standardised test for patient safety - pass/fail ,not used for foundation training - 2024/2025 graduates onwards - Currently, medical graduates sit their final written and clinical exams at their Medical School – and if they pass, they can apply for provisional registration on the GMC Medical Register, then foundation - you are assessed on your Education Performance Measure and your Situational Judgement Test. and FY1 prescribing safely pass

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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.

Answer 9

HS was a practicing GP and was convicted of the murder of 15 patients and forging a will - A move away from single-handed GP practices As Shipman was working on his own, there were few opportunities for colleagues to check on what he was doing. As a result, he was able to murder many without questions being asked - Tighter regulations on the use of controlled drug -Tighter regulation of death certification -Review of the revalidation

Answer 10

step 1: foundation year -after leaving medical school 2 years designed to help young doctors get used to working as "proper" doctors step 2 core training -give trainees a good basis in their area of interest step 3: specialist training -ranges form 4-9 years

Answer 11

https://www.gov.uk/government/publications/climate-change-applying-all-our-health/climate-and-health-applying-all-our-health Why act on the climate crisis in your professional practice The health of the planet is inextricably linked to human health and wellbeing. A healthy planet provides us with our most basic needs: fertile land for food production safe water to drink clean air to breathe The warming of the planet, known as climate change, is degrading our planet’s life-support system and threatens our ability to thrive and survive. Climate change is happening more quickly than previously feared and represents an urgent global crisis requiring a bold, united response. Climate change has been identified as the most important health threat of the century, but it is also the “greatest opportunity to redefine the social and environmental determinants of health”. Everyone working in health and care needs to prepare for and be equipped to respond to the health impacts of the climate crisis. The climate crisis has an important impact on health. Global temperatures are rising at an unprecedented rate, driven by a build-up of greenhouse gases in the atmosphere. These gases, of which the most commonly known is carbon dioxide, are largely a result of burning fossil fuels. Global temperatures continue to rise and are expected to surpass the 1.5 to 2 degree threshold, triggering unprecedented changes to climate systems, with devastating impacts for human health and wellbeing. The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse. (The Lancet, 2021) In the UK, average surface temperature has already risen by 1.2°C and the effects of climate change are already apparent. The UK is particularly at risk of drought, flooding and extreme weather events, all of which threaten the water, food, infrastructure and supply systems we depend on. A warming climate affects health in 3 main ways: Effects of extreme weather, such as heatwaves, flooding, wildfire, storms and drought on physical and mental health (for example injuries and trauma, heat-related illness). Such events are expected to increase in frequency and severity in coming years. Effects on the planet’s life-support systems, such as rising sea levels and safe water availability, changing patterns of zoonotic and vector-borne disease (for example malaria, dengue fever), reduced pollination and crop failure leading to food shortages. Effects mediated by social systems, such as livelihood loss, rising prices of food and fuel, supply chain disruption, pressure on health and care services, conflict or forced migration. The climate crisis affects our efforts to safeguard the health of the population and therefore tackling it as a determinant of health is a crucial aspect of our role as health and care professionals. Actions to prevent and prepare for the climate crisis will improve public health Reducing our contribution to the climate crisis and creating resilience to respond to the worst impacts of a warming climate is an opportunity to protect health. Importantly, much of what can be done is a ‘win-win’ for both the environment and for health. The good news is that greenhouse gas emissions can be reduced in a way that addresses public health challenges; these are ‘win-win’ opportunities. We know that increasing physical activity through active travel, making nutritious and sustainable food readily available and improving air quality and housing will reduce the risk of obesity, cardiovascular and respiratory disease, certain cancers and diabetes. These actions will also help achieve national commitments to reduce our contribution to the climate crisis. Specific ‘win-win’ opportunities for health and the climate crisis Transport Transport is the largest greenhouse gas-emitting sector in the UK, accounting for 28% of total emissions. Our transport system is largely road-travel dependent, and this has been a major factor in reducing physical activity through active travel and increasing obesity-related morbidity and mortality in the UK. Physical inactivity directly contributes to 1 in 6 deaths in the UK and costs wider society £7.4 billion a year. Transport is also a major cause of air pollution. Burning fossil fuels for vehicles and industrial processes fills the air we breathe with greenhouse gases that warm the atmosphere and are released with pollutants that directly impact human health. In the UK, air pollution is responsible for an estimated 28,000 to 36,000 excess deaths a year, with the health costs of air pollution estimated to be between £8.5 billion and £20.2 billion. Find out more about the health impacts of air pollution. If we, as health and care professionals, can help people to increase the number of journeys taken on foot, by bicycle or public transport, we will see benefits for both health and the climate. Housing Homes that lack energy efficiency contribute to climate change and negatively impact our health. Home energy use accounts for 14% of UK greenhouse gas emissions, with the vast majority of energy consumption from coal, oil and gas. Inefficient energy use in homes, as well as rising energy prices, increases the risk of fuel poverty and cold homes. Fuel poverty affects 13.4% of households in the UK. Improving the energy efficiency of homes is the most effective way of tackling fuel poverty in the long term. It reduces the amount of energy required to heat the home and can therefore contribute to reduced energy bills and a warmer, safer home. The burden of ill health from cold homes remains significant in the UK. Living in a cold home represents a considerable risk to health, wellbeing and inequalities. Cold homes are recognised as a source of both physical and mental ill health, increasing the risk of heart attack and stroke, respiratory illness, falls and accidents. Equally, with increasingly warmer temperatures due to global warming, there is also a significant risk to health, particularly for older people, very young children, and those with chronic health conditions of living in a home that is too hot. Ensuring homes are well ventilated can not only help to reduce temperatures on hot days but can also benefit health by improving indoor air quality. If we, as health and care professionals, can help to encourage efficient energy usage in homes, as well as ensure that homes are not too hot or too cold, we will see benefits for both health and the climate. Food Our current food system is a major contributor to global temperature rise, deforestation, biodiversity loss, freshwater overextraction, as well as air and plastic pollution. At the same time, the way we eat is causing significant morbidity and mortality, with poor diets increasing the risk of heart disease, high blood pressure, type 2 diabetes, obesity and certain cancers. Diet-related ill health is estimated to cost the NHS and wider UK society £5.1 billion per year, having a higher impact on the NHS budget than smoking, alcohol consumption and physical inactivity. The foods most damaging to our health are often those with the highest emissions, pollution, land and water use. A diet rich in plant-based foods, and lower in animal source foods which have a significant environmental impact, has benefits for health and the environment. Adherence to the Eatwell Guide which encourages a high consumption of fruits, vegetables, wholegrains and plant-based protein, could contribute to a 7% reduction in mortality and a 30% reduction in greenhouse gas emissions. If we, as health and care professionals, can encourage people to adopt a balanced, sustainable diet and promote wider changes to our food system, we would reduce the environmental impact of food production and supply, as well as reduce the risk of diet-related disease. Green space Our interaction with natural places can have a significant impact on our health. Protecting nature and biodiversity safeguards health and wellbeing. People who live in greener neighbourhoods have higher self-reported health and mental wellbeing. Exposure to green spaces has been shown to improve mood, reduce anxiety, and reduce the risk of type 2 diabetes and cardiovascular disease. ‘Green exercise’, or taking physical activity in green or natural environments, may also provide additional benefits to people’s overall wellbeing. It is estimated that £2.1 billion per year could be saved in health costs if everyone in England had good access to green space, due to the increased physical activity in these spaces. Green spaces can also bring communities together, reduce loneliness and mitigate the negative effects of air pollution, excessive noise, heat and flooding. However, green space access is closely linked to health and social inequalities. The most affluent wards in England have 5 times the amount of parks and green space compared to the most deprived 10% (Public Health England, 2020). If we, as health and care professionals, can promote the protection of green spaces, and implement nature-based interventions for health, such as green walking for mental health or green social prescribing, we can improve the health of people and the planet, while reducing health inequalities. Social and health inequalities The climate crisis and the social justice crisis are closely related. Those most likely to suffer the worst consequences of climate change have contributed the least to it. Deprived areas have the poorest air quality while producing a much lower proportion of housing and travel emissions. The political and economic systems which drive the climate crisis also drive social injustice. The climate crisis impacts people differently depending on their susceptibility, risk and ability to cope. For example, elderly populations, people living in care homes and those with underlying health conditions are more likely to suffer from the effects of extreme heat and cold. Fuel poverty and poor housing can exacerbate these effects. People from deprived areas face disproportionately higher flood risk than those in wealthy areas, particularly in coastal and rural zones, which could mean they are more vulnerable to flood-related financial and livelihood loss. If we, as health and care professionals, act on the climate crisis in a way that addresses social inequalities, we can ensure that the costs of climate action are not unfairly borne by those with lower incomes or other social disadvantages. The health sector is committed to action Policies and commitments at international and national levels require the health sector to take action on the climate crisis. At a global level, the UK has signed the Paris Agreement, a legal commitment to keep global temperatures below 2 degrees Celsius and reduce carbon emissions by 45% by 2030. Commitments made at the COP26 meeting in 2021 put us on track for 2.5 degrees of warming. At a national level, the UK Climate Change Act 2008 requires the government to undertake 5-yearly assessments of climate risks and produce a National Adaptation Plan for responding to the identified risks, including the risks to health and wellbeing as a priority. Within the health and care sector, the NHS in England became the first healthcare system in the world to commit to reduce the carbon emissions it can directly influence (for example, the amount of electricity used by hospitals) to net zero by 2040. Carbon emissions it cannot control but can influence (for example, emissions from manufacturers within the supply chain) will be reduced to net zero by 2045. These commitments are essential because the health and care system in England accounts for approximately 5% of the country’s national greenhouse gas emissions. Particular carbon ‘hotspots’ include supply-chain derived items such as pharmaceuticals and medical equipment, as well as certain anaesthetic gases and patient or staff travel (see graph below). The health system also contributes to plastic and air pollution: in catering alone, the NHS bought at least 163 million plastic cups, 16 million pieces of plastic cutlery, 15 million straws and 2 million plastic stirrers in 2018 one in 20 cars on the road are related to the NHS For a sector based on the principle of “First, do no harm,” the health and care sector must act quickly and collectively to mitigate its own climate damage. Reducing the impact of healthcare on the climate crisis Health and care professionals have an integral role to play in reducing the contribution of the health and care system to the climate crisis. Patient-facing health workers have a particularly important role given they are able to influence how many resources are used and how much healthcare activity is undertaken. Clinical care is responsible for the high-emitting consumption of pharmaceuticals, equipment and consumables, while clinical decisions determine how patients move through the system, for example whether they are admitted to hospital, or how often they need to make a journey to an outpatient clinic. Reaching NHS Net Zero demands that the health and care system becomes environmental, socially and economically sustainable. This will require leadership and innovation from NHS staff. A sustainable health system will: help prevent illness give greater control to patients in managing their health be leaner by streamlining care systems to minimise wasteful activities prioritise treatments and technologies with a lower carbon footprint Core principles for health and care professionals This All Our Health climate crisis information has been created to help all health and care professionals understand that the climate crisis is a problem for health, and how healthcare professionals need to prepare for and respond to it. Health and care professionals are highly trusted and therefore well placed to advocate for action on the climate crisis and the health impacts it has. By acting on the climate crisis, we can safeguard population health against the worst effects of a warming climate. Health and care professionals should recognise the climate crisis as a health crisis, and therefore climate action as a core part of their professional responsibilities. Delivering on this, they can: take everyday opportunities to talk with colleagues, management and patients or clients about the link between climate and health and the importance of taking action now incorporate ’win-win’ interventions which improve health while taking climate action reduce the contribution that health and care has on the climate crisis Taking action Frontline health and care professionals Health and care professionals can implement these core principles by: educating themselves and others about the climate crisis and health promoting and protecting public health reducing the environmental impact of healthcare Educate yourself and others about the climate crisis and health Ask colleagues whether they are willing to make positive changes together. See how to have a climate conversation. Check whether your organisation has a Sustainability Action Plan or Green Plan for NHS Net Zero ambitions. Encourage your professional networks and regulatory bodies to declare a climate emergency as a commitment to climate action. Become a Climate Champion or Environmental Champion, join or start a Green Impact team. Find out how to join climate action and sustainability initiatives at work. Promoting and protecting public health Using the Make Every Contact Count (MECC) approach – use every opportunity to talk to patients and their families about ways they can improve their health which also have a positive impact on the environment. Encourage patients and staff to use active travel when appropriate for them, especially for short journeys. Help patients and staff reduce their exposure to air pollution, and to the risk associated with high pollution episodes. Identify patients most vulnerable to cold or hot weather (children, the elderly, those with chronic conditions), and ensure they know how to keep their homes at a reasonable temperature. Use this online training course to learn how to refer patients for support if they are living in cold homes. Encourage patients and staff to increase their consumption of whole grains, nuts, seeds, plant-based protein, fruits and vegetables, whilst reducing red meat and processed food consumption. Encourage patients and staff to increase their use of green spaces for both physical and mental health. You can make this part of your management plan using these green social prescribing resources. Reducing the environmental impact of healthcare Opt for low-carbon treatments and technologies where appropriate. Use this National Institute for Clinical Excellence (NICE) patient decision aid to help you to discuss with your patient the benefits of switching to a lower-carbon inhaler for their respiratory disease. Anaesthetists, A&E and maternity services staff can reduce the use of highly polluting anaesthetic gases like nitrous oxide or desflurane. Reduce unnecessary resource use. Replace single-use with recyclable or multi-use consumables where appropriate. Reduce the waste associated with prescribing medicines. Actively travel to or at work, using public transport where available, and avoid air travel wherever possible. Use communication technology when appropriate to reduce staff and patient travel. Switch off lights and computers when not in use, reduce paper use and optimise recycling. Help transition towards low-carbon models of healthcare. Use a sustainable quality improvement approach to redesign pathways, processes and services, by embedding sustainability into quality improvement projects. Join a sustainable healthcare network. If you’re an allied health professional (AHP), see this Greener AHP Hub for information and ideas on how your profession can contribute to NHS Net Zero. Team leaders and managers If you’re a team leader or manager: direct team members to information on the climate crisis and health and give them permission to take action on climate change as a core part of their work collaborate with other departments (for example, sustainability officers, catering managers, estates managers) to lead on initiatives that address the climate crisis contact your area’s Green Plan lead or sustainability manager and help develop or implement NHS Net Zero ambitions. use the principles of sustainable healthcare to shape your team’s work Senior or strategic leaders If you’re a senior or strategic leader: declare a health emergency in your department or organisation (see Newcastle upon Tyne Hospital Trust) as a commitment to climate action, and publicise what actions will be taken as part of a declared climate action strategy organise media training for key personnel so they can explain to partners and the public what your organisation is doing and how other organisations can help identify the Green Plan in your NHS organisation, and help develop or implementing it (see King’s College Hospital Green Plan) establish or join Green Champion networks and Green Impact teams improve green space access for patients and staff at your organisation (see NHS Forest) use the NHS’s role as an anchor institution to engage in cross-sector working to influence public services and local businesses to reduce their climate impact work with local authorities and other partners to bring a Health in All Policies approach to cross-sector discussions about key issues (for example, transport, food systems, urban planning), emphasising the benefits to population health of policies that reduce negative environmental impacts take a system-wide approach to sustainable commissioning decarbonise procurement in buildings, infrastructure, catering and equipment implement recommendations from existing climate change response plans: Health and care adaptation report Heatwave plan for England Cold weather plan for England co-ordinate local action across sectors for resilience in the health and care sector (such as hospital preparedness for extreme weather events such as flooding or storms), drawing on evidence of climate risks Understanding local needs Take action on the climate crisis while improving health and reducing social inequalities at a local level: work with your local authority to find out which social groups are vulnerable and identify suitable interventions review the national climate risk mapping tool or the climate risk mapping tool for the London area support health and wellbeing boards to build adaptation actions into local needs assessments understand local climate risks such as flooding and coastal erosion Measuring impact Measuring the impact of your work demonstrates its value and enables its spread: design, measure and report changes to clinical practice using Sustainability in Quality Improvement resources find more information about sustainability reporting guidelines for public sector organisations share good practice ideas through peer networks, the Greener Allied Healthcare professionals hub and Greener NHS Further reading, resources and good practice Education about the climate crisis for health professionals This 2-minute video from the Lancet Countdown on Health and Climate change report, highlights how climate change is a critical public health issue. Free e-learning modules on Environmentally Sustainable Healthcare e-LFH platform. UK government report on the health effects of climate change in the UK. WHO special report: The Health Argument for Climate Action. A webinar series with lectures on climate change, COVID-19 and sustainability. Intergovernmental Panel on Climate Change (IPCC) report on climate change. This report by Medact outlines the public health case for Green New Deal and is an argument for social and economic structure changes to tackle climate change and social injustice. ‘Win-win’ strategies for improving public health and acting on the climate crisis Transport This guide from the Clean Air Fund can be used to communicate the health impacts of air pollution. Social prescribing for active travel toolkit Use these resources to promote physical activity among patients: Get Active physical activity frameworks UK Chief Medical Officers’ physical activity guidelines Housing NICE guideline on the health impacts of cold homes Marmot Review on the health impacts of fuel poverty This Citizens Advice resource can be provided to patients to help them make their homes more energy efficient. Food This brief for healthcare professionals outlines specific interventions for promoting diets than are healthy for patients and good for the planet. The Association of British Dieticians has published a toolkit to help you learn more about environmentally sustainable diets and how to discuss this with your patients. Best practice examples of sustainable food for healthcare. Circular economy for food in healthcare model. Sustainable food and the NHS-recommendations from the King’s Fund. Green space Nature-based interventions, including green social prescribing, walking for health and green space for health. Nature-based interventions for mental healthcare. Green health routes. Social inequalities London’s climate risk mapping training on how to consider at-risk populations. Reducing health inequalities resources Reducing the impact of health and care WHO strategy on environmentally sustainable healthcare. The Clean Air Hospitals Framework can be used to reduce the air pollution at hospital sites for the benefit of patients, staff and the wider community. A list of actions local authorities can take to reduce emissions. The UK Climate Impacts Programme toolkit to help local authorities prepare for the impacts of climate events on organisations and services. Reduce the carbon footprint of inhaler prescribing using this guide developed by Greener Practice. Easy wins for improving energy efficiency through behaviour change in your place of work. Simple steps doctors can take to reduce pharmaceutical pollution Green impact for health toolkit: resources and ideas for improving the sustainability of primary care services. Good practice examples Case studies from the Royal Devon and Exeter NHS Foundation Trust Green Ward competition: these projects embedded sustainability into quality improvement to reduce waste, inappropriate prescribing and unnecessary cannulation across departments. Sussex Community NHS Trust chose to support and promote active travel investing in e-bikes and electric and hybrid pool cares. See the pedal power for cleaner healthcare delivery scheme in action. The ‘Gloves Off’ campaign at Great Ormond Street Hospital shows how simple changes to the way non-sterile gloves are used can significantly reduce the environmental impact of care while improving patient outcomes and experience. The NHS Sheffield Clinical Commissioning Group shows how GP practices can use allotment gardening to provide healthy food to their communities and improve wellbeing. Dorset Integrated Care System integrated climate action into their 5-year plan (2019 to 2024), improving the sustainability of their service and providing care in a way that both protects and recognises the health benefits of nature and the environment. They have made particular progress on leading a whole systems approach to increasing physical activity, a key component of increasing active travel and reducing transport-related climate impacts and ill health. The Greater Manchester Health and Social Care Partnership manifesto uses the health voice to support a transport system which makes active travel the easy and accessible choice. The Yorkshire and Humber Climate Commission brings public, private and third sector organisations together to prevent and prepare for the worst impacts of climate change whilst improving population wellbeing.

Answer 12

The government announced a Better Health campaign to help people lose weight after it was discovered that nearly 8% of critically ill patients with Covid-19 on intensive care units were morbidly obese. That’s compared to 2.9% of the population that is morbidly obese. The measures included: Banning unhealthy food advertisements (classed as foods high in fat, sugar or salt) on television and online before 9pm, with consideration to extend the online ban to apply at all times. Ending ‘buy one, get one free’ promotions and other promotions of foods high in fat and sugar. A ban on these items being placed in prominent locations in stores. Shops should be encouraged to promote healthier choices and offer more discounts on foods like fruit and vegetables. Calorie labelling required by law for large restaurants, cafes and takeaways with more than 250 employees. A consultation to determine whether the provision of calorie labelling on alcohol should go ahead. It has been estimated that around 3.4 million adults consume an additional day’s worth of calories each week from alcohol and it is hoped that alcohol labelling could lead to a reduction in consumption. Expansion of weight management services from the NHS so that more people can get the support they need to lose weight. Including more apps and online tools for people with obesity-related conditions, and accelerating the NHS Diabetes Prevention Programme. A consultation to gather views and evidence on the current ‘traffic light’ labelling system for front-of-pack nutritional labelling to learn more about how it is used and compare it to international examples.

Answer 13

One factor leading to longer response times for ambulance services is the backlog that the NHS is dealing with across all areas of healthcare provision. The decision to suspend much elective treatment during the Covid-19 pandemic meant that the number of people on waiting lists briefly fell. However, as of September 2020 there was a steep climb in the number of people on NHS waiting lists. As of May 2022, there were 7 million people on waiting lists for consultant led elective care. This is more than double the number of people who were on waiting lists in September 2015. BMA (British Medical Association) analysis of waiting times has also found that of these people: 2.75 million people are waiting more than 18 weeks for treatment. Almost 390,000 people are waiting more than a year for treatment. This is 375 times the figure for pre-pandemic July 2019. The BMA are also worried about the ‘hidden backlog’. This refers to people who in normal times would have presented themselves for treatment but chose not to – or had referrals cancelled. Given its nature, the size of the hidden backlog is unknown. However, part of the reason that ambulance waiting times are so long is that, as a consequence of the hidden backlog, people are presenting themselves to the health service later and with more acute issues. A&E Waiting Times Analysis from the Nuffield Trust shows that for less serious visits to A&E departments, the 4-hour wait target from admissions to transfer or discharge has been largely met. In the third quarter of 2021/22, 96% of Category 2 and 3 (minor injuries) visitors to A&E were dealt with within the target 4 hours. However, for Category 1 attendees (the most serious), only 60% of patients were referred or discharged within the 4-hour target. This has an impact on the ability of ambulances to discharge patients, so it is a further cause of delays to ambulance response times. Additional analysis from the BMA has shown that the number of people waiting for more than 12 hours in emergency departments has increased by 14%, and is now 88 times as high as it was in August 2019. Cancer Waiting Times The target time period for a cancer patient being referred from a GP to seeing a consultant is two weeks. 90% of patients should be seen by a consultant in this time. Furthermore, 90% of patients should be receiving treatment following a GP referral. Attendance to emergency departments fell during the pandemic, which helped the NHS to meet certain targets during this time. However, as of August 2022, only 75% of cancer patients referred by a GP had seen a consultant within the target time and 62% of patients had started treatment. Demand on the health service has evidently spiked since the end of the pandemic. However, attendance has only returned to pre-pandemic levels rather than exceeding it, and the number of patients waiting more than 12 hours for treatment in emergency rooms has risen significantly. Causes: covid, the severity of the conditions that patients are presenting with, longer ambulance response times, and changes in wider community health provision.

Answer 14

uch as the severity of the conditions that patients are presenting with, longer ambulance response times, and changes in wider community health provision. Important before gp etc. most pressing is the number of vacancies that have gone unfilled. A recent Skills for Care study found that the number of available posts in the care sector increased by 0.3% in 2021/22, while the number of applications for those roles decreased by 3%. This has led to 165,000 posts going vacant, which is 10.7% of the available posts. This is the highest number on record – higher than the amount of vacant positions in the NHS at 8% or in the wider economy at 4%. In 2022, 4.5 million more people have become unpaid carers There are a number of reasons why there is a staff shortage in the care sector. In 2019, 2020 and 2021, the rise in pay for the average care sector worker did not increase relative to increases in the national living wage. Given the challenges of working in the care sector, this would explain the sluggish recruitment. The government then raised pay for carers in 2021/22 to an extent that it outstripped the increase in the national living wage. The 2021/2022 increase in the average carer’s wage was around 150% greater than the increase in the national living wage. However, this was largely because the increase to the national living wage was far smaller than in previous years. To attract more staff, any pay increase would need to offset the fact that care workers are, on average, not paid as well as comparable jobs in sectors that are often perceived to be far less demanding. For example, the average hourly wage for a care sector worker in 2022 is £9.50. This compares well to kitchen and catering assistants (£8.92), but not to retail assistants (£9.64). Leaders in the care sector cite the relatively low pay and demanding work as a reason why it is difficult for them to fill posts. Another relevant issue is the impact of Brexit on immigration regulations. In January 2021, it became impossible for someone from the EU to gain work in the UK in the care sector. This naturally led to a dramatic rise in vacancies in the sector which had previously relied on EU workers to provide labour. From February 2022, care workers were added onto a shortage occupation list. This means that, as long as the role pays more than £20,480 per year, care workers can be recruited from the EU. Combined with a boost to international recruitment more generally, there is an increasing trend of care workers coming to the UK to find work.

Answer 15

While there has been progress in raising the number of Medical School students in the last few years, and also progress towards the government’s 2019 manifesto commitment to recruit 50,000 more nurses by 2024/25, there has been less progress in ensuring access to GP appointments and Dentists. A report from the King’s Fund has found that the government’s target of 6,000 more GPs by 2024/25 is likely to be missed, as well as the commitment to fund 26,000 more healthcare workers to ease pressure on GPs. A June 2022 analysis by the Health Foundation found that there is a current shortage of 4,200 fully qualified GPs in England. This is projected to increase to 8,800 by 2030. This shortage has meant difficulties in patients seeing their GP in a timely manner, and has therefore likely had an impact on the number of patients presenting to emergency wards. An even more severe shortage is affecting the availability of Dentists. A 2022 BBC investigation found that 9 in 10 NHS dental practices were not taking on new adult patients and that 8 in 10 are not taking on child patients. The problem was worst in the south-west of England, Yorkshire and the Humber and the North West, where 98% of practices were not accepting new adult NHS patients.

Answer 16

https://ehjournal.biomedcentral.com/articles/10.1186/s12940-017-0328-z#Sec2

Answer 17

1. Tell governments real-terms pay cuts aren’t acceptable Nursing staff have been underpaid for at least a decade. Years of real-terms pay cuts have eroded nursing wages, and nursing staff are now comparably worse off than many other professions. This year, nursing staff face yet another real-terms pay cut. That’s why we’re demanding a pay rise for nursing staff of 5% above inflation. We need to take the first step towards restoring your decade of lost earnings. 2. We’re in a cost-of-living crisis Inflation has rocketed, making everyday items increasingly unaffordable. Energy bills are at an all-time high, with many of us wondering how we’ll get by this winter. RCN General Secretary & Chief Executive Pat Cullen has been hearing from members who’ve been forced to use food banks and find second-hand school uniforms for their children. Nursing staff need a fair pay rise to survive in this economy. And given the vital job the profession does to keep the public safe, protecting nursing is the safe and responsible thing to do. Nurses shouldn’t be fighting to survive. 3. NHS nursing vacancies are at a record high There are now over 47,000 unfilled NHS nursing roles across the UK. Thousands of burned-out, underpaid nursing staff have left the profession in the past 12 months. We need fair pay to help fill these vacancies and prevent more nursing staff leaving. 4. Nursing student numbers are falling The latest UCAS figures showed a 7% drop in applicants accepted onto nursing courses, compared to last year. Although nursing graduates initially earn above the median wage, 10 years into their careers, their earnings fall below the median and stay there. Increased student loans have a further negative impact. If we can’t do more to make a nursing career more attractive, the nursing workforce crisis will only get worse. 5. Patient safety is already suffering With so many nursing vacancies and staff working through stress and burnout, patient safety is already at risk. Earlier this year, we asked nursing staff about the conditions during the last shift they worked. Eight out of 10 told us there weren’t enough nursing staff to meet all patient needs safely and effectively. Only 18% said they had enough time to provide the level of care they’d like. Taking strike action is your chance to make a stand on behalf of your patients and their safety. 6. We can strike safely Our historic industrial action in Northern Ireland in 2019-20 showed that nursing staff can go on strike without risking patient safety. Patients are always our priority and we have plans in place to make an impact through strike action while making sure safety critical care is covered. Read more in this article. 7. Nursing staff are regularly working unpaid overtime In our survey of 10,000 members, conducted in late 2021, three-quarters of nursing staff said they work beyond their contracted hours at least once a week and 17% reported doing this every working day. This means, in real terms, your wage is worth even less per hour. You deserve better pay. 8. COVID claps don’t pay the bills Many of you worked through difficult conditions during the COVID-19 pandemic, putting yourselves at risk to deliver vital patient care. Ministers clapped you and called you heroes, but actions speak louder than words. So far, their actions have fallen short. You kept the UK going during the most difficult time in recent history. Nursing staff should be paid fairly – kind words and claps are not enough. 9. We’re stronger together Governments have ignored our demands for fair pay and conditions so far. But there are hundreds of thousands of nursing staff and if we all stand together, governments can’t ignore us. You’re the voice of the RCN – in England, Wales and Scotland we need at least 50% of all eligible members (those working for NHS and HSC employers on Agenda for Change contracts) to return their ballot paper before we can take action and demand governments listen to your concerns. 10. Nursing staff deserve better You know that nursing is important and rewarding, but also one of the toughest jobs out there. You see patients when they’re scared, alone, at crisis point. You’re a highly skilled professional who knows what patients need. You work extra hours and it’s hard to shake off the day when you get home. But you’re dedicated and you want to do the best for every patient. You deserve a fair wage that reflects the challenges, intensity, and skill of your role. You deserve fair pay now.

Answer 18

If nurses go on strike there will be disruption to planned appointments and procedures, the RCN has said. This would likely lengthen backlogs and waiting lists. There would, however, be measures in place to ensure patient safety is not at risk. Studies have shown that short-staffing, whether caused by strike action or workforce crisis, has a “profound effect on nurses’ ability to do their jobs, increases rates of medical error and leads to preventable patient deaths”. A spokesperson for the Department of Health and Social Care said they hoped nurses would carefully consider the impact any strike action would have on patients. “We value the hard work of NHS nurses and are working hard to support them,” the spokesperson said. The government increased the basic pay for newly qualified nurses by 5.5 per cent earlier this year, however most nurses received a rise of around 3.7 per cent.

Answer 19

BAME Patients BAME patients also face inequality when they seek to use NHS services. Some of these issues include: Death during childbirth. Black women are five times likelier than white women to die in childbirth. Women of mixed ethnicity are also three times likelier to die and Asian woman are two times more likely. Detrimental health outcomes. The Marmot Report states that detrimental health outcomes associated with some ethnic groups are associated with their socio-economic, and sometimes economic, status.

Answer 20

BAME and COVID-19 The impact of COVID-19 has been disproportionately felt by the BAME community. Some of the key issues include: Disproportionate mortality and morbidity. In the first month of the pandemic, 95% of NHS Doctors who died of COVID-19 were from BAME backgrounds. The disproportionate death rate in BAME staff is only partially explained by health conditions, age and socio-demographic factors. Staff scared to raise COVID-19 concerns. Formal disciplinary processes are more common amongst BAME groups in comparison to their white counterparts, which could be a reason behind fear of raising COVID-19 related concerns or asking for safer alternatives. What Is The NHS Doing To Address This? NHS England and NHS Improvement are working to address BAME inequalities that COVID-19 has highlighted. Some of the measures include: On 30th April 2020, NHS Employers published guidance for NHS organisations to take appropriate measures to mitigate the risk of COVID-19, including taking ethnicity and age into account alongside other factors. NHS Employers published guidance for NHS organisations to ensure appropriate measures are taken to mitigate the risk of COVID-19, which includes taking in ethnicity into account. The assessment should consider whether adjustments to work should be made or whether redeployment is more appropriate. A bespoke health and wellbeing offer, which includes rehabilitation and recovering, for BAME colleagues is being created in addition to various existing resources. Over £4M was provided by UK Research and Innovation and the National Institute for Health Research to fund six research projects investigating the links between COVID-19 and ethnicity.