NHS & Doctors

NHS Core values

• Respect & dignity

• Commitment to quality of care

• Compassion

• Improving lives

• Working together for patients

• Everyone counts

NHS Workforce plan (15 year) + what year was it published?

Increase annual training places from 2023

• Med school places 7500 → 15000

• GP training places 4000 → 6000

• Double nurse training places +24000

• More training places offered for degree apprenticeships

Challenges faced by NHS

Lack of funding

• Not keeping up with demand for healthcare services - Long waiting times, difficulty maintaining high-quality care

Staff shortages

• Pressure on workforce - Burnout, compromised patient care

• Longer waiting times

Backlog from covid

• Waiting times

• Targets for 2024 were missed

Challenges faced by doctors

Poor working conditions, low pay, lack of jobs

• Led to strikes

• Led to doctors leaving country

Places pressure on other doctors

Issues with A&E

4 hour rule hasn’t been met nationally in any month since 2015 due to:

• Rising attendance

• Fewer beds

• Ageing population

• Unnecessary attendances

• Delayed discharges

• Staff shortages

Solutions for A&E issues

• New emergency/urgent care hubs - Reduce pressure on A&E

• Education - Prevents unnecessary visits to A&E

Issues with ageing population

3.2 mil people aged 80+ in UK (2021)

• Predicted to increase greatly

• Higher prevalence of chronic conditions (diabetes, Alzheimer’s) so more support needed, but insufficient resources/staffing - Other areas take a hit

• Social care cuts - Increased A&E and hospital admissions

2025 resident doctor strikes (dates + reasons)

14^th November - 19^th November

• Better pay

• Better working conditions

• More training places

Who is UK health minister?

Wesley Streeting

Levels of care in NHS

Primary - First point of contact

• A&E

• GP

Secondary care - Specialist care

• Hospitals

• Clinics

Tertiary care - Highly specialised/advanced treatment for complex issues

• Regional/national care centres

Funding structure in NHS

Devolved - Each county is responsible for running its own healthcare system

• Department of Health & Social Care - Manages overall budget to fund NHS

• NHS England - Oversees healthcare & plans/buys NHS services with CCGs

• Clinical Commissioning Groups - Commission healthcare services as per population needs

• NHS Trusts - Hospitals trust, Ambulances trust etc. that provide care to NHS patients

Issues with GPs & primary care

• Workforce shortages

• Increasing demand due to population growth

• Practices closing

• Unsafe workloads for GPs - Some seeing almost double the patients that they should be

• Long waits for appointments

Solutions for GPs & primary care

• More encouragement to take up GP training after med school

• “Golden Hello” payments of up to £20,000 for GPs that become partners at practices facing recruitment challenges

• NHS has scheme to incentivise FY doctors to become GPs

Arguments against doctors striking

• Defies non-maleficence

• Doesn’t honour beneficence

• Costs NHS (around £240 mil for 2025 walkout)

• Puts extra stress on other members of MDT

Arguments for doctors striking

Many doctors moving abroad due to low pay or lack of jobs

• Worsens understaffing

Lack of training places & jobs will lead to a lack of consultants in the future

• May affect patient care

What is medical licensing agreement?

Pass/fail assessments that aim to standardise quality care

• For all UK & international graduates

• Applied knowledge & clinical/professional skills

Arguments for privatisation of NHS

• Helps with waiting lists & reduces waiting times

• Allows for better doctor’s income - More incentive for doctors to stay in UK

• Reduces unnecessary visits

Arguments against privatisation of NHS

Affects justice

• Less accessible to less wealthy

• More expensive for those with chronic diseases

• Could be more financial-focussed than patient-centred

What are the Francis reports?

A public inquiry into poor care at Mid Staffordshire NHS Foundation Trust

• Appalling treatment

• Unnecessary suffering - 400-1200 died unnecessarily in 2005-2008

Main recommendations made by Francis reports

Almost 300

• Protection of those who report wrongdoing at work

• Training & regulation of healthcare assistants

• Recruitment & training of new/current registered nurses

Government responses to Francis reports

• Actions to improve patient care - Increase openness & changed hospital regulations

• Guidelines on staffing capacity to ensure safety

Bawa-Garba Case outline & mistakes

6 year old Jack Addock died under care of Dr Bawa-Garba

• Chest x-ray was seen over 2 hours late - Bawa-Garba wasn’t told that they were ready

• Antibiotics prescribed late

• Blood test results were reported over 5 hours late - Hospital computer system failings

• Medication stopped for heart condition - Not documented & Jacks’s mum not told

• Bawa-Garba called of resuscitation - Confusion between Jack for a DNAR patient

Failings of hospital in Bawa-Garba case

• Hospital was understaffed - Bawa-Garba had workload of 2 doctors

• No senior consultants, insufficient senior nurses

• Hospital computer systems failing & no notification about x-ray

• Nurses didn’t tell Bawa-Garba tha Jack was deteriorating

Charlie Gard case overview

Has MDDS (problems with mitochondrial DNA = trouble producing energy) - Affects functions of brain, heart, kidneys & liver

• Couldn’t move or open his eyes - Impossible to tell when he was in pain

• Only one treatment available - Hadn’t been tested on humans or animals to treat Charlie’s specific syndrome, but proved effective for similar

• Parents wanted treatment, court ruled against it due to low chance of success & risk that he was in pain

• Life support removed & Gard died

Alfie Evans case overview

Suffered from a degenerative neurological condition - Admitted to hospital after suffering seizures

• Parents wanted to fly him to Rome to prolong life - Hospital staff & court decided it was not in his best interests

• Life support was removed and he died

Ethics linked to Charlie Gard & Alfie Evans

• Autonomy - Parents right to decide

• Beneficence - Treatment isn’t best thing for patient in these scenarios (removing life support ended pain)

• Potential benefit of treatment was insufficient to justify the use of public resources