Hot topics in NHS

7 Day NHS

So NHS being open for 7 days that was first raised in the 2015 election. So, by 2020, patients wait no longer than 14 hours for inital consultant review. Access to diagnostic tests withing 24-hour turnaround. There was research into the weekend effect => where research showed that patients likely die at the weekend compared to during the weekday. Why this might not be necessary? => Out of hours services are already available for patients needing urgent care, so opening GP surgeries may not be necessary. By opening in the weekend => there would be more CT and MRI scans which means the buget will be increased.  

In conclusion: To open a 7-day NHS to be successful and effective, staffing levels would need to be improved and budget towards ever-increasing demand of dignositic scans is unlikely to be a reality. 

Junior doctors contract - was seen as an effort by the Government to introduce a 7day NHS to address the weekend effect without increasing the funds available for the NHS.

• Increase in basic pay by 13.5 %

• Extra hours would be reduced

This effects Junior doctors, who are not consultants, from foundation year doctors to senior regiesters.

So, regardless of the increase in basic pay, they would not be paided extra for working additional hours. This could be a problem if instead of 5 days rota, the junior doctors had to work for 7 days, this could lead to them having greater strain in work and less able to provide safe care to patients.

So, (British Members Association - BMA) Voted strike in Nov 2015, and strikes took place between January and April 2016. So this meant that consultants had to work in the stead of junior doctors (some may argue that at this time the NHS was more effective as experienced doctors where giving treatment. However, the drawback is that it reduces the experience that junior doctors obtain while the two years out of medicine where they are rotating around wards and getting a better idea - they would have a lack of this if they went on strike).

Although there has been an increase of 28.9 percentage increase and a further 5% increase, BMA argue that this does not restore the pay levels from 2008 (due to inflation, and is not kept as international comparisons).

Additionally, there are about 30 000 foundation doctors that are ready for speciality training, but only 10 000 positions available. Additionally, with the shortage of staffing levels. If due to this doctors go away from UK to abroad it fulls more into the problem.

What solutions should be put in place instead of stiking?

• Maybe Doctors can voice their conerns outside of working hours to minimise impact on patients.

Doctors and the Media

There are positive and negatives with relationship between doctors and the patients via media.

Negatives:

• There are many medical drama that have been filmed and telecaseted (Grey’s Anatomy and the good doctor), which offer insight into working of real hospital, and these shows show a representation of doctors on TV and effect public’s opinion. Which might lead to stereotypes: That an arrogant surgeron with a scalpel in the hand liking the inside of the patient rather than having a conversation with them. Additionally, when rare medical conditions are consistently aired onscreen, the public begin to expect them such as in a patient comes with a red swelling on their thigh it could be a common skin infection (cellulitis) rather than a life threatening bacterial infection. They might also expect to see miracle cures because they are used to seeing this on screen.

Positives:

• Social media can be utalised by doctors, GP practices and hospitals to raise awareness of health-related issues (WHO surgical checklist has improved safety in operating theatres across the world)

It is important to maintain public trust, so this can protect the trust between doctors and patients. This is important so that the patient is more likely to discuss about their worries without worrying about them being judged, and allows the doctor to get a full picture of the condition that the patient has.

A shortage of new doctors joining the NHS:

In 2018, there was a check on vacancy numbers in the NHS, which means there was a shortage of medical staff, putting patients at risk. This means that a lack of staffing => long waiting list periods, overworking of GPs.

The introduction to teepees as a result of increasing levels of anxiety, stress and suicide:

With the increase in poor mental and physical health => teepees are created ‘public living rooms‘ (NHS and camerados, a social movement to bring about more human connection in the world). The aim was to provide an opportunity of reconnecting humanity and supporting each other through difficult times. (Jenny Clarke, Midwife at Blackpool victora hospital stated ‘There is emerging evidence that NHS staff who take breaks away from their work environment are more rested and able to cope with pressure and are kinder‘)

Brexit and the NHS

At 11pm January 31st 2020, UK has left the EU (europe). European Medicines Agency (EMA) is central for European pharmaceutical regulation, due to brexit UK is no lnger in the EMA. As a result, medicines may be required to go through multiple approval processes so they can be used across Europe. So this means, that drugs will have to be separately approved by the MHRA and EMA. So more time and money is required to obtain the drugs. Additionally, any emerging new drugs manufactured at pharmeaucutical companies had to rethink its strategies, where there was a delay in UK gaining these medication. {Brexit has seem to have acted as a catalyst for investment in the UK clinical research programmes, with higher output than ever despire the uncertainty.} => This sentence means, the UK government aim to solidify UK’s position as a science and technology superpower. There is impact on supplies of medicine

KEY NOTE FOR THIS FLASHCARD:

Do not express a strong opinion, make sure you stay neutral talking about both sides of the argument.

Is the NHS in crisis?

• There is an increase in healthcare expenditure: In 2024, UK healthcare expenditure was 11.1% of GDP, which is higher than before the COVID-19 pandemic, but lower than the peak years of pandemic.

• Funding sources: the NHS is mainly funded by general taxation and National Insurance, with a small fraction generated through patient charges for services like prescriptions and dental treatment.

• Ageing population + increased cost: With an older population, is more costly to the health system, as older individuals tend to require more medical services and care.

Artificial intelligence and its place in medicine

• When health care proffessional ask for samples of data from patients, they are trained to asking questions and undertaking the right conclusions, so enables you to draw the right conclusions and provide the best treatment for patient. However, machine learning algorithms are shown to pick up problems.

  • However, if the algotithm makes a mistake there is no clear line of accountability is it the developers fault, the consultant or the algorithm.

  • Utalising machine learning, will save time so that doctors can focus on more tasks, and money.

• However, it is important that while using AI in medicine, to better screen, diagnose and treat patients, medicine is a social profession where there is doctor and patient contact, so that there is a sense of familiarity between doctor and the time of life when an individual is vulnerable.

A new antidepressant nasal spray: But why hasn’t it been approved?

• The antidepressant nasal spray, must demonstrate clinical and cost-effectiveness, because the drug may have immense clinical benefits for patients, but if it is too expensive there is no chance it can be scaled across the entire NHS

The new cholesterol-lowering injection

• It works by silencing genes that produce LDL in the blood, so with reduced LDL there is less build up on the walls of arteries and can reduce life-threatening problems such as heart attack or stroke. The drug works by preventing the production of a protein in the liver, so has a greater ability to remove LDLs from the blood and then lowering LDL levels.

The rise of antibiotic resistance:

• With the increasing use of antibiotics, this is caused more bacteria to become resistant.

• Additionally, if resistance develps at its current rate, the World Health Organisation estimates that by 2050, antibiotic resistance would result in 10 million deaths per year.

However, pharmaceutical companies aren’t investing heavily in the development of these medications. Why?

• The cost of buying these medications are very low, making it difficult for them to develop.

• Patent expiration: Once a pharamceutical company synthasises this drug, other companies will look to form cheaper versions of the drug, so the origional company will find it difficult to make profit

How is big data being used in Medicine?

Genome sequencing: 

• Genome sequencing is commonly used to look at the genetic material of specific organism and cells, so that researchers can gain an understanding of cancer-inducing genes.

Wearable and earlier diagnosis:

• The electronic health records, can be used by physicians to form a personalised care plan for patients

Ethical issues: This large amounts of data, have the patients given permission for companies to use this data, additionally if there was a security breeche this can effect patient confidentiality and reduce public trust in doctors. So, effective security measures need to be put in place.

Telemedicine

Consultations:

• if the patient is unable to see the doctor, this allows healthcare proffessions to access patient records remotely.

  • It is difficult to form a theurapetic bond between the doctor and the patient. (to build rapport)

  • The platform needs to secure in a way there is no technological breeche

  • Make sure this information is discussed in a private location so no breach in patient confidentiality

  • If a CT or MRI scan is required this is only available at the hospital.

Telesurgery:

• Where wireless networks are used to connect a surgeon in one area to robotic surgical technology in another area, so there is immediate access to high-quality care and reduces potential surgical complications.

  • The reason I was intereseted to disucss this is because during a Biology in action day, Tim Underwood, presented himself as an experienced surgeon (for Oesophageal cancer) and discussed about the evolution of sugery. He explained some drawbacks, where with the adancing AI many people would gain experience in performing acurate surgery, however what if there was no technology at the time of casualty (we should be able to learn hands on and AI surgery). Additionally, there is a time delay between twhen the surgeon takes the action and the robot following this action.

Should Euthanasia be legalised?

For

• During the debate regarding the Assisted Dying Bill in 2024, it was highlighted the importance of autonomy, compassion and argue that current laws force individuals to endure unnecessary suffering or seek assistance abroad (some area of USA have euthanasia as legal). Campaigners stated, where some individuals have often had to travel abroad to receive assisted dying services.

• But there should be safeguards in position, in case of pressuring someone into choosing assisted dying.

Against:

• There could be vulnerable people who are pressured into assisted dying, which would undermine efforts to improve palliative care.

• If there was an incurable disease and person has passed away from assisted dying - where they could have been saved.

• Many believe in the sanctity of life, where life is sacred and should never be intentionally ended.

• It is difficult to determine who should be legally offered assisted dying.

• Additionally, the role of the doctor is to help and heal, with assisted dying does that mean doctors have more power?

Background info: the Assisted Dying Bill 2024 is currently under discussion => where allows patients expected to die within 6 month to make a legally supported choice about ending their lives.

Euthanasia (Doc administers life-ending med) // Assisted dying (doc prescribed med, but patient administers it themselves)

Organ donation:

Before, through an app you can opt in or opt out if you want to become an organ donor through an app. However, now law has changed and it will be considered you agree to be an organ donor when you die: you are over 18, you have not opted out and you are not in an excluded group.

Excluded groups: those under 18, visitors to England, ppl who have lived in England less than 12 months before death.

Why was it introduced?

• Wales introduced an opt out system in 2015 and saw an increase in number of families supporting one’s decisions to donate - saving more lives. Similarly want to see if this system will allow more people to agree to support organ donation and help save and improve more lives.

For:

• More organs would be donated, which fulfill the current deficit in supply of organs.

Against:

• It is possible that some people do not know about opt out system that their organs are donated against their will.

• Respect, some religions believe that after death the body should be intact.

Living donation: when the donation of a whole or partial organ from a living person to another person in need of a transplant. (typically organs that can regenerate: liver, kidney, lungs)

Resistricts if any in place for recieving organ transplants: clinical necessity (are all other options exhausted before a transplant is considered) + Survival chances (the chance of survival after surgery) + support system (so they have a support system that can help them through the recovery process) + Risk factor (transported organ not damaged e.g. alcoholism) and tissue match and quality of life

Organ sales and ethical concerns surrounding this:

• Legalising the sale of organs, which increases the organ availability

• Even if organs were sold to NHS and allocated fairly, people may feel pressured to sell their organs for money

Questions around the new NHS app and digital healthcare:

Latest features and developments through the NHS app:

• Comprehensive health records: Where Users have access to their GP health records, medicines and allergies => IMPORTANT: Users can actively participate in their healthcare by having a clear overview, improved accuracy (they can access their own records and identify any inaccuracies), enhanced safety for the patient themselves. // reduces administrative burden, and improved data quality (data is up-to-date)

• Appointments: Patients can book, manage and cancel their appointments, as well as view waiting times (fewer missed appointments, allows patients to manage their appointments anytime, reduces anxiety => reduces patients to constantly check back with their GP)

• The users can order repeat prescriptions and nominate a pharmacy for collection (this still means it has to be approved by a healthcare profession, and reduces the time spend waiting)

Negatives of the app:

• Digital divide: It is important that everyone has the skills to operate online, if someone doesn’t know how to operate the NHS app this will then be difficult to utalise the benefits.

• There is a language barrier, currently the NHS app and digital healthcare is only available in English.

• Some prefer face-to-face: which is available

Huntington disease

Huntington’s disease is an inherited condition, that causes nerve cells in the brain to break over time, affecting movement, thinking and behaviour. Caused by an error in part of the DNA called the huntingtin gene. This mutation causes a normal protein needed in the brain (huntingtin protein) into a killer of neurons.

New treatment: is a type of gene therapy, given during the 12 - 18 hours of delicate brain surgery. Uses a modified virus to deliver new DNA instructions into brain cells, which create a molecule that targets and destroys the cells’ own mutant huntington RNA.

What are my thoughts on this?

Positive aspect of potentially curing huntington’s disease: Huntington’s disease runs through Jack May-Davis family, Jack said it was really awful and horrible to watch his dad’s death, which couldn’t be prevented. He was bracing the idea that he was going to be destined to share the same fate as his father, until today. He is now able to look into the future to think it seems brighter and allows me him to think his life could be much longer. => allow to prevent deaths through the genetic disease through the family, giving them hope and a chance to live longer. This allows the person to live longer and the family will be able to have longer with each other. Through stepping into the new therapy, this will encourage more new emerging technologies.

Negative aspects (challenges): The treatment was safe, but some patients developed inflammation from the virus that caused headaches and confusion (that resolved or required steroid treatment). The drug is not available to everyone due to the highly complex surgery and anticipated cost. Long-term implications are unknown.

THIS THERAPY HAS SLOWED THE PROGRESSION OF HUNTINGTON’S DISEASE. NOT CURED.

Key dates

COVID 19:

• First National Lock down: 26 March to 4th July 2020

• Second national Lock down: 5th November to 2nd December

• Third National Lock Down: 6th January till 8th March (schools opening)

• Vaccination administered on 8th December 2020

Junior Doctors strike:

NHS founded: 1948

Ageing population:

• There is an increase in the older people in the population.

• This places challenges in the NHS and social care in the UK

• Social care (support provided to individuals who require assistance due to age, illness and other challenges)

  • Helping with personal care (bathing, feeding and dressing)

  • Domestic help (household tasks)

  • Medication management (medications are taken correctly and on time)

• The reason due to aging population, is because life expectancy has changed over time, with improved nutrition, hygiene, control of infectious disease and other public health measures.

• Although living longer, there is an increased amount of time living in poor health.

There is a correlation between social care and healthcare in the UK:

• With the NHS struggling to provide care for everyone that needs it (long waiting lists, not enough beds, and many vacant staffing posts), this directly affects social care as those needed for hosptial interventions (surgeries) are forced to be looked after in social care settings, if they are struggling to cope until they can access hospital care.

To improve:

• There should be increased investment in social care, increased access to technology (so telehealth and remote monitoring reduces need for hospital visits)

Key things to remember when answering data interpretation stations.

• COVID-19 pandemic has caused an increase in mental health issues, increased in drug usage, increased in at home alcoholic consumption

• Aging population

• Public health campaigns: to help raise awareness

• Economic factors: socioeconomic factors (inflation)

• Cultural shifts: more people wanting a healthier lifestyle.

Summary on the implications to Abortion in the UK

• Abortion is legal up to 24 weeks of pregnancy

  • The person’s life is in danger

  • The foetus has severe abnormality

  • The woman is at risk of significant physical or mental injury

• Medical termination in first 10 week, then it is surgical termination after 10 weeks

• The concept of the unconcious violinist, you find yourself attached to them and you are their life support, if you detach yourself they die.

  • There is the autonomy of your choice to detach yourself so that they can either die or live

Pros:
- Patients have the right to decide what happens to their body

- Patients have the right to remove themselves from risks to their own health

- An embryo does not have the capacity for independent life

Cons:

- Human life begins at conception

- Babies can be put up for adoption

- Abortion can carry physical and mental risks

Artificial intelligence

• AI is improving healthcare, by automating tasks improving diagnostics and streamlining operations.

  • Diagnosis => pattern recognition to process large number of scans

  • Treatment => Used in the development of personalized treatment plans for patients (taking into account past medical history)

  • Drug discovery => Can identify new drug targets and screening drug candidates

  • Admin => Operational efficiency (by automating administrative tasks using AI)

• AI is already present in helping radiologists, powerful virtual wards and identifying patients at risk at chronic illnesses.

AI in NHS:

• Virtual wards, where hospital-level care is provided from healthcare proffessionals while the patient is still at home. This is possible due to AI as AI facilitates this through smart monitoring of patient’s health parameters.

• AI algorithms are being used to screen mass amounts of patient data to highlight patient at risk of developing chronic illnesses.

• Supporting radiologists in screening X-rays to identity concerning features, so radiologists can focus more time on complex cases.

Advantages:

Faster data analysis, earlier identification, drug discorvery and personalised treatment, telemedicine.

Disadvantages: Bias, security and data privacy, patient trust (some patients would prefer seeing doctors face-to-face), accountability if there was an incorrect diagnosis, who would be in charge of the complications of this fault.