NHS HOT TOPICS Flashcards
Obesity Crisis: define, factors, impacts, prevention vs treatment
Obesity Crisis: abnormal or excessive fat accumulation that may impair health
Factors: food, activity, stress, sleep, health/medication, environment, genetics.
Consequences:
Act as a comorbidity, fatty liver disease, heart disease, cancer.
Worse mental health, poorer quality of life.
Weight bias affecting quality of care.
Can affect ability to exercise.
Prevention Vs Treatment:
Prevention is cheaper than treatment for NHS (bypass surgery)
Prevention avoids long term consequences of obesity (mental health, comorbidities)
Weight regain from treatment is highly common.
Prevention is rarely effective, Some types of obesity cannot be prevented (genetic)
Education and social campaigns are hard to justifiably fund when money can go towards life-saving surgeries.
Treatment is highly effective and simple in certain cases (levothyroxine)
Travel Vaccinations: purpose, why, which ones, where, cost, risks, if i dont get it.
Travel Vaccinations:
Protection from infectious diseases for the individual and wider community and also to abide by the law of certain countries.
Why now? Required when travelling to countries where these infections are widespread
Which ones: depends on the country.
Where? Get in touch with GP or book online.
Pay? Some are available on the NHS whilst others aren’t.
Risks/side effects: commonly mild flu-like symptoms, pain at site of injection, serious risks extremely rare.
What if I don’t get vaccination: significant health risk, may not be allowed to leave/enter country.
Social media: types, professional boundaries, benefits, risks, Do’s, Don’ts
Social Media: blogs and microblogs (twitter), internet forums (doctors.net, student room), content communities (YouTube) and social networking (Facebook, LinkedIn).
Jan 2020 3.6 billion people use social media, ~50% of population.
Boundaries: blurred boundaries between public and private life of doctors, creates a risk of patients learning too much about a doctors life.
Benefits:
Patient education – disseminating useful and reliable medical information.
Promoting Health, healthy habits and lifestyle to larger public,
Raising awareness covid and strain on NHS.
Networking establishing nation and international medical online support networks.
Risks:
Royal society of Public Health (RSPH) 2017 study young people (16-24) who spend 2+hours on social media are more likely to report mental health issues, depression and anxiety. ‘Compare and Despair attitude’, ‘Facebook depression’ and suicidal ideations.
Poor mental health is linked to poor sleep which creates a harmful cycle leading to increased risk of high bp, obesity, diabetes, heart attack, stroke.
~40% of young people experience cyberbullying on a high frequency basis, possibly underestimated due to fear and stigma surrounding reporting incidents.
Using social media as a place to vent out feeling studies show only perpetuate low mood and self-esteem, whereas posting positive activities promote positive effects.
Suggestion by RSPH of a pop-up warning of screen time over 2 hours.
Digital media training. Tackling mental health conditions over social media use.
Dos: highest privacy, only post images you’d like anyone to see, kindly dismiss any patient friend requests.
Don’ts: no medical advice, never post about patients or workplace, post personal pictures which may impact professionalism.
Substance Abuse: define, issues, causes, solutions, help, dangers, approach
Substance Abuse: Able to quit and change behaviour, alcohol OTCs, heroin, tobacco, marijuana
Issues: mental, social, work-related, self-harm, danger to public.
1 in 6 doctors in UK suffering from drug/alcohol addiction.
Causes: long hours, extended schedules, anxiety caused by patient care.
Solutions: workplace testing, psychological support, rehabilitation support.
Help: colleagues, superiors, family members, non-profits (Adfam), self-help.
Dangers: patient health/safety, public perception, self-harm, academic/work-place performance, social/personal life.
Approach: behaviour, smell, start locally, ask for advice from seniors, offer support.
Ageing Population: define, causes, consequences, Do’s. Don’ts, solutions
Ageing Population: proportion of elderly people increase (life expectancy or decreased birth rate)
Causes: improved medical care, fewer deaths from infectious diseases, switch to chronic diseases as main cause of death. Fewer children/later on.
Consequences:
Higher prevalence of chronic diseases can act as comorbidities.
Older people require longer hospital stays due to more complex illnesses.
Longer care (to make a complex care plan), reducing hospital capacity and increased demand for beds. ‘bed blocking’
Preventative care increasingly required.
Costs to medicate, staff and run hospitals increasing.
More opportunities for employment to meet elderly needs.
More stress for social care workers, putting pressure on the interlink between social care and healthcare.
Do’s:
Keep a broad perspective, of the patient, healthcare staff and government.
Suggest potential solutions.
Specific conditions eg CHD.
Don’ts:
Don’t be dismissive, not a burden.
Don’t be unprepared for counters: consider flipsides and incorporate.
Solutions:
Increase investment in social care
Encourage heathy living
Support family caregivers, training
Increase access to tech, telemedicine and wearable devices
Improve integration of care, social and health to receive the appropriate care at the right time.
Ambulance Response times: categories, missed targets, impacts
Measure of performance = response times
Category 1-4 on urgency of situation with a corresponding ideal response time
Ideal response time is averaged across response time and 90% target. (just 90% for 3/4)
1: life-threatening, cardiac/resp arrest = Av <7mins 90% within 15 mins
2: serious stroke angina, rapid assessment required = Av <18 mins 90% within 40 mins
3: urgent requires treatment and transport to hospital = 90% within 2 hours.
4: non-urgent, stable clinical cases require transport to hospital = 90% within 3 hours.
April/May 2022:
Cat 1 8.36 mins 1.36 mins over target on most urgent calls where seconds count.
Cat 2 Av 40 mins way above target
Cat 3 2 hours 9 mins.
Compromises patient safety.
High demand post-covid, 20% increase in a year, 860 000 calls to 990k in April 22
Post-2010 cuts to community services, more acute issues entering health system later,
Reports of Ambulance in London taking 70 mins to respond to suspected heart attack.
Report of a patient in stoke dying after waiting 8 hours for an ambulance.
Paramedic shortage – GMB Union 1000 ambulance workers left since 2018 to have a better work life balance.
A&E waiting times, overcrowding slows down offloading and responses to other calls.
Government allocated £150 million to address this and a 3% pay rise to NHS workers.
NHS budget 150 bn.
Backlogs: causes, impacts
Covid-19 suspension of elective treatment meant that in sep 2020 waiting lists increased steeply.
For consultant led elective care May 2022 7 million people, double sep 2015.
BMA: 390k people waiting over a year, 375X Pre-pandemic figures.
BMA also worried about ‘hidden backlog’, This is causing people to present themselves later to Ambulances with more acute issues.
AE waiting times. Cat 2 and 3 4 hour target for admissions to transfer/discharge met
cat 1 60% success on the target, delaying ambulances. Number of people waiting over 12 hours increased by 14%, 88x higher than Aug 19.
Cancer: target, real stat, causes
90% Target from GP referral to consultant is 2 weeks. (Aug 2022 75% seen, 62% treatment)
90% should receive treatment following a GP referral.
Similar Attendance to health service to pre-covid but longer waiting times means that there must be other factors responsible such as condition severity and longer ambulance response and wider community health provision.
Doctors and Dentists: shortages, impacts
Progress in raising the number of med students and progress to 201 manifesto to recruit 50k more nurses by 2024/25 however less progress to access to gps and dentists.
Reports found that the target of 6k more gps by 2024/2025 unlikely to be hit as well as the funding of 26k more healthcare workers to ease pressure on gps.
Current shortage of 4.2k gps in 2022 projected to increase to 8.8k in 2030.
Led to longer waiting times and increase in presentation to emergency wards.
Dentists, 9 in 10 NHS practices were not taking on new adults and 8 in 10 not taking on children, Yorkshire and the Humber 98% not accepting new adult patients.
Care: define sector, vacancies, causes, impacts
Care sector: all roles that support people who require specialised assistance to live their daily lives.(elderly, young families, mental illness, addiction)
Increase in number of unfilled vacancies in care sector, 11% of available care roles vacant.
Led to less support, more emergency admissions and also non-professional care, 2022 4.5 million people became unpaid carers since the pandemic, bringing the total to 13.6 million.
NHS Vacant roles (8%)
Wider economy (4%)
Reasons for care staff shortage:
No increase in wage adjacent to increases in national living.
2021-2022 saw the increase in pay for carers but still to an average of £9.50 lower than retail assistants (£9.64)
Brexit immigration regulations Jan 2021 made it impossible for EU workers to work in the UK Care sector, increasing vacancies.
Feb 2022 Care workers were added onto the shortage occupation list, as long as the role pays more than £20480 per year care workers can be recruited from the EU, now increasing trend of care workers coming into the UK. (10% starter carers EU)
7 Day-NHS: Background, goals, pros, cons, progress, projections, ethics
Conservative government in 2015, goal to provide care 7 days a week in response to evidence that health outcomes vary when patients are admitted at the weekend.
Initial prospects are that people can book gp appointments or emergency care and would receive the same level of care as during the week.
Goals:
Patients admitted to AE must be seen by a consultant in 14 hours.
7-day access to diagnostic services.
Must have access to consultant-directed interventions 7-days a week.
Patients in high dependency areas of the hospital must be seen by a consultant twice daily and once taken to a general ward once daily.
Focus on consultant work as they were previously able to opt out of working non-emergency shifts at weekends.
Pros:
High quality care at all times
Discharged at weekends, increase beds.
Continuity of care over weekends, consultant led review daily.
Those working 9-5 will find it easier to get appointments.
May ease waiting times.
Cons:
Accurate documentation required, high volume of documentation increases error leading to confusion in review dates.
Understaffing still an issue.
Vagueness of goals to doctors, which patients count as emergency and when does the window for the 14-hour review begin.
Funding is already dire, expanding care will only worsen the funding issues.
Progress to current:
Health visits for mothers and babies and mental health often operate 24/7.
More diagnostic and primary care services are available.
However GP appointments still difficult to get despite 27% increase in GPs since 2019;
Future projections:
Department of Health and Social Care Plan to improve GP service:
Tackle 8am rush of phone calls
Ensure patients know how their request to a GP practice is being managed.
Despite the dire restraints understaffing and funding bring to halt the progression of 7-day NHS:
Tech advancements, telemedicine, digital health services will aid achieving a 7-day NHS.
Strategic planning, funding and continued commitment to patient outcomes is required.
Ethics:
Autonomy – patient choice expanded to seek out-of-hours appointments, having wider range of emergency service access at weekends.
Beneficence/non-maleficence: reducing harm by striving to provide better care and reduce mortality rate.
Justice: fair to receive same level of care on weekends as weekdays.
Understanding the balance between 24/7 quality care, understaffing and backlogs is very important.
Doctor Degree Apprenticeship Programme: background, purpose, pros, cons, impact
In partnership with Health Education England (HEE), aims to redefine medical education, offering a unique path to medicine in 2023/2024.
East Suffolk Medical Doctor Degree Apprenticeship Application Sep2024 start
HEE- non-departmental public body responsible for overseeing the education and workforce development of healthcare professionals.
Purpose:
Allows student to gain practical experience from the start to complement their academic learning with the same entry requirements.
Increase the diversity, accessibility and representability of local communities whilst retaining high standards.
Enable employers to recruit apprentices as part of their local workforce plans.
Pros:
Broadens access to med careers and diversifies future demographics of doctors.
Offers a viable financial alternative by providing a salary from the beginning.
Promotes inclusivity and cultural competence in healthcare.
Provides early exposure to medical practice.
Helps alleviate financial burdens compared to uni.
Cons:
Juggling work and study requires excellent time management.
Adapting to a different learning environment that integrates practical from the beginning.
Navigating demands of the workplace alongside academia.
Requires careful consideration of personal circumstances and readiness to embrace the apprenticeship model.
Impact:
Controversy about reduction in standards, there are rigorous requirements to enter the programme and continue within it, achieving qualifications comparable to those obtained through traditional uni.
Still adhering to GMC guidelines upholds integrity and professionalism of the medical profession.
Curriculum and assessments ensure they are well prepared.
Increases diversity of talent previously pursued by a narrow proportion of the population.
NHS Winter Pressures and Bed Shortages: background, why bed shortages, impacts, ethics, future solutions,
In 2023, NHS faced significant bed shortages and most hospitals were operating at an unsafe capacity.
Yearly, winter months increase demand and decrease bed availability.
Bed shortages and winter pressures result in poorer care through delayed treatment and longer wait times.
Government launches a number of initiatives to combat the pressures on the NHS in 2023.
85% is the safe occupancy level of hospitals, number of beds has decreased by 17230 over the last decade leading to increased bed occupancy.
Why:
Ageing population, more frequent and longer admissions.
Increasing service demand with population.
Covid-19 enhanced infection control reduced bed capacity and this has not been restored in 2023.
Pressures in social care has delayed discharge.
Understaffing limits the hospitals ability to utilise available beds as efficiently as possible.
Nov to March, more beds required, staffing shortages and waiting times increase.
Delays in social care and prolonged stays for elderly patients increases patient load and increases pressure to accommodate for new admissions.
NHS hospitals often operate at near full capacity which is quickly filled in winter leading to distressing scenes of patients lying on beds in corridors in AED.
Increased illness, injuries due to poor weather conditions and exacerbation of chronic conditions increase demand.
Impact on Patient Care:
Dealyed treatment and increased waiting times.
Increased risk of infections, overcrowding, HA Infections.
Compromised patient dignity, corridors AED, Against NHS vales.
Poorer patient care from overworked staff, burnout, adverse working conditions.
Greater demand for Critical Care beds, unable to provide specialised care.
Ethics:
Resource allocation to ensure equitable access between specialities.
Triage to prioritise based on clinical need.
Maintaining privacy and dignity where possible.
Quality of Care irrespective of resource limitations.
Future plans:
2023 Winter pressures plan:
5000 more beds
800 new ambulances, over 1 million more ambulance road hours.
100s of new virtual ward beds.
Reducing occupancy rates by reducing unnecessary admissions and delays in discharge
Social care investments.
Key focus is streamlining discharge, over 12000 patients occupying beds despite being mofd, a nationwide rollout of care traffic control centres is in progress.
Care traffic control centres offer a platform to swiftly locate and coordinate optimal discharge for patients, drawing data from patient records and housing services, could facilitate the discharge of up to a third of patients by December 2023.
To respond to increases in resp illnesses, NHS plans on expanding Acute Respiratory infection hubs which offer urgent assessments for covid flue and rsv, serving 730000 patients and expediting access to care.
NHS Long-Term Workforce Plan: background, need for plan, inadequate training, includes,part 1, 2, 3
Comprehensive strategy aimed at addressing the current and future challenges of the health sector.
Need for the NHS Workforce plan:
Constant need for more staff: Predicted shortfull of 260-360000 full time equivalents by 2036/37
Shortfall of Doctors of around 15000 GPs by 2036/27
Shortfall of 37000 community nurses by 2036/37 up from 6500 shortfall I 2021/22.
Shortfalls in learning disability and critical care nurses expected due to fewer applications and international recruitment.
Reliance on temporary staffing is used a measure of shortfall, 150 000 ftes used in 2021/22 to meet demand.
Plans to combat shortfalls by increasing training to grow the workforce, improve culture to retain workforce and reform work and training practices to improve quality of care.
Inadequate training and education:
Recruitment of healthcare professionals have not med demand, requiring the NHS to rely heavily on international recruitment.
Half of the doctors who joined the workforce in 2021 were international medical graduates, half of new nursing registrants in 2022 were trained overseas.
Implications of overseas workforce:
High marginal labour costs
Longevity? As global demand also increases.
112000 vacancies in NHS as of March 2023, UK lags behind average OECD country in terms of Medics per population.
Workforce needs to become more preventative and a shift to chronic care is required as an ageing population becomes more prevalent.
NHS Long term Plan includes:
Bolstering primary and community care
Investing in mental healthcare
Early cancer diagnosis
Focusing on population health, integration and prevention.
¼ of the NHS come from an ethnic minority background.
PART 1 Training and Growing the workforce:
Increasing education to record levels required-
Expanding apprenticeship and alternative routes into professional roles.
60-100% Increase in medical school places.
Double the number of Medical school training places
Increase the number of GP specialist training places by 45-60% by 2033-34.
Increase number of speciality training places for areas with greatest shortages and also foundation year placements.
Goal is to have 2000 apprentices by 2031/32.
PART 2 retain with right culture:
Implement NHS People Plan and improving flexibility for prospective retirees.
Reduce leaver rate from 9.1% in 2022 to around 8%, retaining 55-128 thousands FTEs.
NHS People Promise and People plan will change the culture and provide more flexible working options.
Increase representation of diversity at senior levels and increase opportunity to get there.
Modernising the NHS Pension Scheme and developing a clear employee value proposition.
Ensuring there is a clear Freedom to Speak up approach to increase engagement.
Invest in occupational health and wellbeing services and supporting staff who experience abuse.
Ensure staff have access to continuing development and supportive supervision or protected time for training.
Improve work flexibility and strengthening multidisciplinary leadership and management.
PART 3 Reform:
Growing skills and capacity to deliver care closer to home.
Increasing number of staff in primary community and mental health services. (nurses from 30 to 37%)
Training healthcare professionals who can work effectively in MDTs.
Significant investment in funding tech and innovation to boost labour productivity.
Increase Digital innovations, NHS AI Lab currently have 86 projects in 444 live settings involved with 3-5 year trials showing promising results.
Automation of back office tasks could save more than 7.2 million hours annually 30% cost reduction.
Efficient workforce entry: allowing nurses to enter paid employment up to four months earlier reduces reliance on temporary staff.
Integrated care systems are recognised as having a central role in implementing the plan.
NHS Postcode Lottery: Define, impacts, causes, improvements, ethics
Postcode lottery: unequal access to healthcare services across different regions based on geographic location.
Impacts: IVF Specialist services mental health support.
Causes of postcode lottery:
Autonomy in Budget Allocation across ICSs
Differential Health needs in different population demographics.
Socio-economic factors requiring more investment in comprehensive health services.
Poor/better integration of health and social care services affecting efficiency of care.
Policy decisions locally and nationally.
NHS England is now split into different ICSs introduced in 2022.
ICSs focus more on local populations rather than organisation and competition
Ethics:
Autonomy: restricted as there are fewer choices on certain procedures in various regions.
Beneficence/non-maleficence: harm is not entirely minimised across the whole country.
Justice: Different levels of care in comparison to other areas of the country, no justice.
