Public Health Flashcards
Name some inequalities of the modern NHS
Newly licensed drugs available according to postcode lottery
Waiting lists for hip replacements vary from area to area
Potentially life prolonging treatments are denied as they are not cost effective
What is rationing within the NHS defined as?
When anyone is denied an intervention that everyone would agree would do them good and which they would like to have
Who deserves the newest drugs/best medical treatment
Consequentialism would advocate the provision of medical treatment which produces the best overall consequences, ?taking into account the benefits that an individual would give to society by having treatment
QALYs are used in the NHS (quality adjusted life years) but may be seen as ageist and may be subjective
What is a QALY?
A quality adjusted life year
Measurement designed to assess the number of years and the quality of those years that a treatment would give a patient
A year of life with perfect health=1
Treatment is beneficial if it improves this
Allows financial cost to be assessed per quality life-years gained
Who suffers from the use of QALYs?
Older people
Terminally ill people
How could healthcare be allocated using lifestyle considerations?
Patient’s lifestyle and social worth
Implies someone who is responsible for their own ill health is less worthy of treatment than someone who is blameless
eg denying operations to people who are obese/smoking
Should a doctor continue to treat someone who misses appointments and is non compliant with medication?
GMC states it is unethical to withhold treatment based on lifestyle
What are the core aims of ‘Putting Patients First’?
Provide better support for people to self-care
Help people with urgent care needs to get the right advice in the right place, the first time
Provide highly responsive urgent care services outside of hospital so people no longer choose to queue in A+E
Ensure that those people with more serious/life threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and good recovery
Is the NHS required by law to provide healthcare?
Duty for Secretary of State for Health to:
Continue the promotion in England of a comprehensive health service designed to secure improvement (a) in the physical and mental health of the people of England and (b) in the prevention, diagnosis, and treatment of illness
ECHR Right to life does not equate tor right to healthcare
How does NICE help with allocation of resources?
NICE is an independent organisation that gives guidance to the public and to healthcare professionals on the use of new and existing treatments and procedures within the NHS
Clinical benefits of new and expensive treatments are examined and NHS funding bodies are advised about what circumstances drugs should be prescribed
If a drug is expensive and would not usually be prescribed under NICE guidance, what an be done?
Individual funding requests from the relevant clinician are given to a Patient Individual Needs (PIN) panel
They must demonstrate that their case is unique/exceptional to justify funding
If it is a cancer drug, an application should be made to a national funding body
Are prophylactic mastectomies ethically justified?
Up to 90% reduction in risk of breast cancer
BUT no increase in life expectancy
Psychological impact of no breasts
Risk not definite
Risk still left as not all tissue is removed
Risks of surgery (non-maleficence)
NICE says it is appropriate if patient is high risk
What needs to be true for a screening programme to be justified?
The condition must be an important health problem
The natural history of the condition should be adequately understood
There should be a simple, safe, precise and validated screening test
The test should be acceptable to the population
There should be am accepted treatment or intervention
There should be agreed evidence-based policies covering which individuals should be offered treatment and the appropriate treatment to be offered
The opportunity cost of the screening programme should be economically balanced in relation to expenditure on medical care as a wholeWhat
Name some UK screening programmes
Down's syndrome Infectious diseases in pregnancy Antenatal sickle cell and thalassemia AAA Diabetic retinopathy Breast, cervical and bowel cancer
Aims of screening?
To identify whether asymptomatic patients are at an increased risk of a disease or condition
They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease/condition
What is herd immunity?
The level at which the population of those non-immunised is sufficiently small that the risk of catching the disease amongst that group is negligible
