NHS hot topics Flashcards
What is a vaccine and how does it work?
- giving a small amounts of weekend/inactive form of a pathogen
- the immune system will recognise the antigens on the pathogens, and will trigger a response to fight them, like producing antibodies (active immunity).
Why are vaccines used?
1) herd immunity- if lots o people are vaccinated those who are not can be kept safe
2) Mass protection - less people will fall ill and then a lower strain on healthcare resources
What are children generally vaccinated against?
measles, mumps, rubella, meningitis, hepatitis and polio
Vaccines and its side effect
- vaccines are hugely safe
- they have short-term side effects like tenderness swelling and irritation
- long0term ones are much rare
Why do people have vaccines if the have side effects?
its very rare to have extreme side effects
- majority of people will have short term discomfort
- this short-term side effects will out way the negative impact of being infected by what the vaccine provides immunity for and they often have life long illnes because of it or death
They reduce impact on health resources
What is herd immunity, why is it good
infectious diseases move between organisms (vectors like humans)
by vaccinating means we remove there vectors as we make them immune- humans
Why is it good for others to vaccinate?
small number of population are immunosuppressant or very sick or not able to have the vaccine.
if we remove the vectors, then pathogen cant spread and will protect these groups of people (they are must more likely to be exposed)
Why are people against to compulsory vaccination?
- concerned about the health effects
How can you promote vaccine uptake?
- vaccine uptake has fallen
- parents are less likely to vaccinate if they haven’t had a frank discussion with HCP- communication is key and effort is needed
- limited by the availability of appointments
Why is compulsory vaccination bad?
- could cause more distrust between patient and doctors, so issues in the log run, like not getting help with more serious isses
What are the alternative of mandatory vaccines
- education - talks at schools,
What is vaccine hesitancy?
- the delay in accepting or complete refusal of vaccine despite the resource being there.
Why do people have vaccine hesitancy?
Complacency - when they dot think they have a high risk of getting the disease or prioritise another health of life issue
Convenience- how accessible and affordable? its free, walk-in and online booking
Confidence- are people confident in their doctor? Education in what are the pros and cons but listen to concerns whilst showing empathy. Invalidating them will reduce the confidence in the healthcare system and be further reluctant
Kettle facts of Junior doctor strikes
– Junior doctors have seen a 26% real terms pay cut
Since
– Newly qualified junior doctors earn £14 per hour,
they are saying that should rise to £19 per hour
– The NHS is in a workforce crisis:
– There are 8,700 medical posts vacant in England
– There are 124,000 NHS staff vacancies in England
– 7.2m patients are on waiting lists
– We have 2,078 fewer fully-qualified, full-time GPs
than we had in 2015.
– Four in ten (40%) of junior doctors say that they will
leave the NHS as soon as they can find another job
– Pay restoration is essential to the future of the NHS
How many medical posts vacant in England? And NHS staff vacancies in England?
- 8700
- 124,000
How long is the waiting list?
7.2 million
How many fewer fully-qualified, full-time GPs
than 2015?
2078
Percentage of junior doctors say that they will
leave the NHS as soon as they can find another job?
40%
What is DDRB
Review Body on Doctors’ and Dentists’
Remuneration (DDRB) and is intended to be an independent
body that makes recommendations each year on what to
pay doctors and dentists.
What is the basic 40 hrs pay pf a junior doctor?
£29,384
£14.09 an hour
What is in the junior doctors’ multi-year pay deal?
In the multi-year deal, agreed in 2019 before the pandemic, junior doctors in England were guaranteed a 2% increase each year for four year
If junior doctors get a 2% increase each year, what is the issue?
the contract was agreed before the pandemic started and when inflation was below 2%. Our new calculations show that pay awards for junior doctors in England from 2008/09 to 2021/22 have delivered a real terms (RPI) pay cut of 26.1%, even accounting for total investment secured through the multi-year pay deal agreed in 2019.
What are the 3 aims of the junior doctor strikes?
- achieve full pay restoration to reverse the steep decline in pay faced by junior doctors since 2008/9
- agree on a mechanism with the Government to prevent any future declines against the cost of living and inflation
- reform the DDRB (Doctors’ and Dentists’ Review Body) process so pay increases can be recommended independently and fairly to safeguard the recruitment and retention of junior doctors.
4 challenges the NHS is facing
Ambulances, Backlogs, Care, and Doctors & Dentists.
Each categorys ideal response time for ambulance
Category 1: An immediate response to a life-threatening condition, such as cardiac or respiratory arrest. The average response time should be under 7 minutes and 90% of ambulances should arrive within 15 minutes.
Category 2: A serious condition, such as stroke or chest pain, which may require rapid assessment and/or urgent transport. The average response time should be under 18 minutes and 90% of ambulances should arrive within 40 minutes.
Category 3: An urgent problem, such as an uncomplicated diabetic issue, which requires treatment and transport to an acute setting. 90% of ambulances should arrive within 2 hours.
Category 4: A non-urgent problem, such as stable clinical cases, which requires transportation to a hospital ward or clinic. 90% of ambulances should arrive within 3 hours.
What are the current ambulance waiting times?
- As of April/May 2022, while Category 1 calls see an average response time of 8:36 minutes (only 1:36 mins above the target average wait)
- Category 2 calls see an average wait of 40 minutes. This is far above the target average of 18 minutes
- Category 3 calls, with the average response time of 2 hours 9 minutes. The target states that 90% of ambulances should have arrived within 2 hours
Causes of long ambulance wait times
- The ambulance service is seeing unprecedented levels of demand post-Covid. There were 860,000 calls to 999 made in England in April 2022, up 20% on the previous April.
- Post-2010 cuts to community services have resulted in greater pressures on the emergency services, as people previously treated in the community are entering the health system later and therefore with more acute issues.
3.Shortage of paramedics. The GMB union has found that 1,000 ambulance workers have left the service since 2018 to seek a ‘better work-life balance’.
4.A&E waiting times. Emergency departments have become overcrowded, and this slows down ambulance crews. Ambulances are having to wait with patients until space in the emergency department becomes available. This slows their ability to respond to other call requests.
How has the government addressed ambulance waiting times?
has allocated £150 million to specifically address ambulance waiting times and has given NHS workers a 3% pay rise in order to incentivise retention. For context, the £150 million figure represents 0.1% of the overall NHS budget of around £150 billion.
What Is Meant By An Ageing Population?
There are currently 3.2 million people over the age of 80 living in the UK, and this number is expected to reach nearly 8 million by 2050. By this point, 25% of the population will be over 65.
Although a longer life expectancy is a positive effect of good healthcare (and is therefore a trend commonly seen in more economically developed countries),
an ageing population also increases the burden on healthcare systems.
Why do we have an ageing population in the UK?
Increased Life Expectancy: Advances in healthcare, medicine, and overall living condition
Declining Birth Rates: The birth rate in the UK has been decreasing
Improved Quality of Life: Improved socio-economic conditions and quality of life have led to individuals having fewer children and focusing on career and personal development, contributing to lower birth rates.
Changes in Family Structure: Changes in family dynamics, such as delayed marriage and childbearing, have contributed to a decrease
Economic Factors: Economic factors, such as the cost of raising children, housing expenses,
What are the negatives of a ageing population?
Increased Healthcare Costs: An aging population often requires more healthcare services, leading to higher healthcare costs for the government and individuals. Age-related illnesses and chronic conditions become more prevalent, placing a strain on healthcare systems.
Economic Impact: An aging workforce may result in a decline in the overall labor force and productivity. This can impact economic growth as there are fewer people contributing actively to the workforce, potentially leading to a slowdown in economic development.
What is polypharmacy, how is it related to an ageing population?
simultaneous use of multiple medicines by patients for various health conditions
- ageing pop= more complex patients
What is the Charlie Gard case?
The Charlie Gard case was a legal case of best interest, involving the paediatric patient Charlie Gard, who had a rare mitochondrial DNA depletion syndrome, meaning he had progressive brain damage and muscle failure.
He was admitted to Great Ormond Street Hospital (GOSH) in London, where doctors determined that the condition had caused irreversible damage to his brain and organs.
Why was there a disagreement?
- Charlie’s parents sought permission to take him to the United States for an experimental treatment called nucleoside therapy, which was not available in the UK.
- GOSH medical professionals argued that the experimental treatment would not benefit Charlie and could cause further suffering without a realistic chance of improvement.
“futile and would only prolong Charlie’s suffering”.
What were the legal proceedings?
- The hospital sought permission from the courts to withdraw life support and allow Charlie to die peacefully. This decision was based on medical assessments indicating that Charlie was in irreversible pain and suffering.
- The case went through various levels of the UK legal system, including the High Court, the Court of Appeal, and the Supreme Court.
- The courts sided with the medical professionals at GOSH, ruling that it was in Charlie’s best interests to withdraw life support and allow him to pass away.
Did charlies parents appeal?
Charlie’s parents appealed to the European Court of Human Rights, seeking permission to take him to the United States for treatment.
The ECHR ultimately upheld the previous decisions of the UK courts, stating that further treatment would not offer a realistic chance of success and would prolong Charlie’s suffering.
What happened at the of the charlie gard case?
In July 2017, Charlie Gard’s parents withdrew their legal challenge, acknowledging that his condition had deteriorated to a point where further treatment was not viable.
Charlie Gard passed away on July 28, 2017, shortly after being moved to palliative care.
What is the Bawa-Garca Case
On 18th January 2011, six-year-old Jack Adcock had been feeling unwell – he was having difficulty breathing, as well as vomiting and diarrhoea. Jack had Down’s Syndrome and a known heart condition, and required long-term medication.
He was admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following his GP’s referral. Jack’s condition deteriorated that day and he passed away.
Junior Doctor Hadiza Bawa-Garba, a paediatric registrar in year six of her speciality training (ST6).
Dr Bawa-Garba was taken to High Court and on 4th November 2015 was found guilty of manslaughter on the grounds of gross negligence.
What was the timeline of events of the Bawa-Garba Case
Dr Bawa-Garba ordered a chest X-ray that showed an infection. The X-ray results were available from 12:30, but didn’t get seen until 3pm. Then prescribed antibiotics, which were administered at 4pm. Prescribing antibiotics earlier could potentially have led to a different outcome, but the ward was understaffed and Dr Bawa-Garba was extremely busy. Furthermore, she had not been made aware that the X-ray was available at 12:30.
A blood test revealed high levels of C-Reactive Protein (CRP), which occurs due to infection and inflammation. This was reported over five hours late, due to failings in the hospital computer system.
she stopped the medication for his heart condition. However, she did not document this in his notes, and subsequently, this medication was administered to Jack at 7pm by his mother. Jack’s mother was unaware that he was not to be following his usual course of treatment for his heart condition.
Jack suffered a cardiac arrest at 8pm. Dr Bawa-Garba was one of the Doctors who attended the call and arrived when resuscitation was already taking place. Dr Bawa-Garba mistook Jack for another patient, whose notes were marked as DNAR (do not attempt resuscitation), and therefore Dr Bawa-Garba called off resuscitation. Resuscitation was re-continued shortly after the mistake was identified. Jack died at 9:20pm.
What were the failings within the hospital system?
- Dr Bawa-Garba was carrying out the work of two Doctors and the hospital was extremely understaffed.
- Senior consultants were not on-site and therefore Dr Bawa-Garba had no one to report to. There were not enough senior nurses on the ward, either.
- The failings of the hospital computer system prolonged blood testing results. There was also no system in place to notify Dr Bawa-Garba that the X-ray was ready for analysis.
-Nurses did not notify Dr Bawa-Garba that Jack was deteriorating.
-The administration of medication for Jack’s heart condition was not carried out by Dr Bawa-Garba.
What was the legal battle of he Bawa-Garba case?
- Dr Bawa-Garba was taken to High Court and on 4th November 2015 was found guilty of manslaughter on the grounds of gross negligence.
- This Court ruling resulted in Dr Bawa-Garba being suspended from 12 months from the GMC register. The GMC applied to have her permanently struck off the medical register. However, the Medical Practitioners Tribunal Services (MPTS) refused this application, stating “erasure would be disproportionate”.
- January 2018. The GMC appealed against the MPTS decision in the High Court. The appeal was successful and resulted in Dr Bawa-Garba being struck off the GMC medical register
-Crowdfunding. Following public outrage from Doctors
What are social care beds?
- given to medically stable patients who still require additional support and attention
- used between transition between hospital and home
