NHS hot topic

Euthanasia and Assisted Dying

Following the passing of the bill for assisted dying to be made legal in the UK for patients within 6 months of dying, answer the following question: Should euthanasia and assisted dying be part of modern medical practice?

This is a deeply complex question that requires balancing patient autonomy with safeguarding vulnerable individuals.

I believe the recent bill represents an important step toward respecting patient autonomy—allowing terminally ill patients within six months of death to choose a dignified end aligns with the NHS value of compassion. For patients experiencing unbearable suffering despite palliative care, this choice can provide comfort and control during their final months.

However, I have significant concerns about implementation. The six-month prognosis isn't always accurate—some terminal conditions are unpredictable. There's also the risk that vulnerable patients might feel pressured by family or perceive themselves as burdensome, which conflicts with the principle of non-maleficence. We must ensure any framework includes robust safeguards: psychiatric assessments, mandatory counselling, and multiple independent medical opinions.

I'm also mindful of the impact on healthcare professionals. Assisted dying fundamentally changes the doctor-patient relationship. We'd need comprehensive support systems for staff who may face moral distress, alongside clear opt-out provisions for those with conscientious objections.

Rather than viewing this as binary, I think the focus should be on strengthening palliative care while carefully implementing assisted dying with strict eligibility criteria. The emphasis must remain on improving quality of life and ensuring informed, unpressured consent.

Antimicrobial Resistance

The discovery of antibiotics in the 1940's has revolutionised modern medicine and the treatment of infections. However, with the ever increasing rise in antimicrobial resistance, we are being forced to reconsider how we use these precious drugs. Discuss the main factors contributing to the rise in antimicrobial resistance and the impact this has on clinical practice.

Antimicrobial resistance is one of the most pressing challenges facing modern medicine. The main contributing factors span multiple areas.

Firstly, inappropriate prescribing—often driven by patient expectations for antibiotics when they're not needed, like for viral infections. There's also incomplete treatment courses, where patients stop taking antibiotics early, allowing resistant bacteria to survive.

Beyond healthcare, agricultural overuse is significant—antibiotics given to livestock can promote resistance that transfers to humans through the food chain. Globally, poor infection control and limited access to diagnostics mean antibiotics are sometimes used as a precautionary measure rather than when definitively needed.

The impact on clinical practice is profound. We're seeing routine procedures like caesareans and chemotherapy becoming riskier because post-operative infections may be untreatable. Hospital stays are longer, treatment costs increase, and mortality rates rise for previously manageable infections.

As future doctors, we must embrace antibiotic stewardship—prescribing only when necessary, choosing narrow-spectrum options, and educating patients about why "just in case" antibiotics do more harm than good. This aligns with NHS values of patient safety and effective resource management.

We also need innovation—investing in rapid diagnostics and new antimicrobials—alongside global collaboration, because resistant bacteria don't respect borders.

Privatisation

Privatisation of the NHS has been a long discussed topic. Outline the benefits but also the drawbacks of increased privatisation of the national health service and discuss it's controversy.

Privatisation in the NHS is controversial because it balances efficiency against core NHS principles.

The benefits include potentially reducing waiting times by easing pressure on overstretched services, bringing innovation through competition, and improving resource allocation where the NHS lacks capacity.

However, the drawbacks are significant. There's a real risk of creating a two-tier system where profit motives could compromise patient-centred care. It may fragment care pathways, making coordination harder, and could undermine the principle of equitable access—a fundamental NHS value.

I think limited, well-regulated private involvement for specific services like diagnostics could help, but core NHS services must remain free at the point of use. Any privatisation needs rigorous oversight to ensure patient safety and quality aren't sacrificed for profit, and that it genuinely supports rather than undermines universal healthcare.

The key is protecting what makes the NHS special—equity and accessibility—while pragmatically addressing capacity challenges.

• Accident and emergency waiting times

What are the possible impacts this could have on healthcare?

A&E waiting times have a massive knock-on effect across healthcare. For patients, delays can be really dangerous—if someone's having a stroke or developing sepsis, every hour counts. We saw at Darent Valley how time-sensitive conditions are, and delays genuinely worsen outcomes.

For staff, it's exhausting. They're working flat out but still can't give timely care, which leads to burnout and moral distress. I saw nurses in the phlebotomy clinic managing so many anxious kids back-to-back—you could see the strain.

Systemically, it creates this vicious cycle. Bed-blocking means patients can't be admitted, so ambulances queue outside, and then routine surgeries get cancelled, which makes waiting lists even longer.

We need better social care to help discharge patients, more community services to prevent admissions in the first place, and genuinely supporting staff wellbeing. Effective triage helps, but ultimately we need to address the underlying capacity issues properly.

Public Health

What are some public health campaigns you've seen recently? Discuss the impact that the public health campaign has on healthcare and the difficulties / benefits associated with the public health campaign you name.

I've noticed the "Get Vaccinated. Get Winter Strong" campaign encouraging flu and COVID vaccinations for vulnerable groups.

The impact is significant—it reduces preventable hospital admissions during winter pressures, protecting both individuals and NHS capacity. It aligns with NHS values of prevention and addressing health inequalities by targeting high-risk populations.

However, challenges include vaccine hesitancy, particularly in underserved communities, and misinformation on social media undermining trust.

To address this, we need targeted outreach through community leaders and GP practices, culturally sensitive messaging, and clear communication about vaccine safety. Collaboration with local organizations can help reach those who distrust mainstream campaigns.

Ultimately, prevention is more cost-effective than treatment, so investing in these campaigns protects both public health and NHS sustainability.

• Biggest challenges facing the NHS

What do you believe are the biggest challenges facing the healthcare system today, and how would you propose addressing them?

I think the biggest challenge is workforce—we're absolutely hemorrhaging staff. Doctors and nurses are burnt out, and we're not replacing them fast enough. We need to look after our people better, because if they're struggling, patients suffer.

The other huge issue is demand massively outstripping capacity. We've got an aging population with increasingly complex needs, but we're still operating a very hospital-centric model. I think we need to shift resources upstream—invest in community care and prevention to stop people getting sick in the first place, rather than just treating them when they're already really unwell.

And honestly, social care is the elephant in the room. People who are medically fit are stuck in hospital beds because there's nowhere for them to go. We need proper integration between health and social care.

Obviously these aren't quick fixes, but if we don't address workforce and prevention now, we'll just keep firefighting.

© The Case of Alfie Evans

What do you know about the case of Alfie Evans and what was the controversy surrounding it?

Alfie Evans was a toddler with a severe degenerative brain condition. His parents wanted to take him to Italy for further treatment, but doctors believed continuing life support wasn't in his best interests as there was no prospect of improvement, only prolonged suffering.

The controversy centered on parental autonomy versus medical expertise. The courts ultimately sided with clinicians, prioritizing Alfie's best interests under the principle of non-maleficence.

This case highlights the importance of compassionate communication and early involvement of mediation services when disagreements arise. While parents naturally want to exhaust every option, doctors must make evidence-based decisions focused on the child's welfare, not just prolonging life.

It's a reminder that medicine requires balancing clinical judgment with empathy, transparency, and respect for families during incredibly difficult circumstances.

• Bawa-Garba Case

What do you know about the Bawa-Garba case and the impact it has had on healthcare as a whole?

The Bawa-Garba case involved a junior doctor convicted of gross negligence manslaughter after a tragic death in 2011. She was working under severe pressure—staff shortages, IT failures, and systemic issues that contributed to the outcome.

The case sparked huge concern because it appeared to blame an individual for systemic failures, creating a culture of fear rather than learning. This impacts healthcare by discouraging reflective practice and honest reporting of errors, which are essential for patient safety.

While individual accountability matters, we need a just culture that distinguishes between human error in difficult circumstances and genuine negligence. Solutions include legal protections for reflective practice, better staffing, and robust support systems.

The focus should be learning from mistakes to improve systems, not punishing individuals for failures beyond their control.

© NHS Winter Pressures

It is widely known that the NHS is currently under a lot of strain, particularly during the winter period.

Why is this and what impact does it have on patients and staff?

Winter pressures occur because colder months bring surges in flu, respiratory illnesses, and exacerbations of chronic conditions like COPD, all hitting simultaneously.

For staff, it's exhausting. They're working flat out but still can't give timely care, which leads to burnout and moral distress. I saw nurses in the phlebotomy clinic managing so many anxious kids back-to-back—you could see the strain.

Systemically, it creates this vicious cycle. Bed-blocking means patients can't be admitted, so ambulances queue outside, and then routine surgeries get cancelled, which makes waiting lists even longer.

We need better social care to help discharge patients, more community services to prevent admissions in the first place, and genuinely supporting staff wellbeing. Effective triage helps, but ultimately we need to address the underlying capacity issues properly.

• Charlie Gard Case

What do you know about the case of Charlie Gard and what was the controversy surrounding it?

Charlie Gard was an infant with a rare mitochondrial disorder. His parents raised funds for experimental treatment in the US, but doctors at Great Ormond Street believed it wouldn't help and would only prolong suffering.

The controversy centered on parental rights versus medical expertise in determining a child's best interests. The courts sided with clinicians, applying the principle of non-maleficence—avoiding further harm when there's no realistic prospect of improvement.

This case highlights the need for compassionate, transparent communication between medical teams and families. Early involvement of ethics committees and mediation services can help navigate such conflicts.

Ultimately, decisions must be evidence-based and child-centered, but delivered with empathy, recognizing the profound grief parents experience when facing impossible situations.

• Primary Care Services

There has been increasing demand on primary care services across the UK as pressure on the National Health Service increases. Why are primary care services under so much pressure and what do you think the consequences could be on the NHS?

So primary care is really struggling right now, and there are a few main reasons for that. We've got an aging population where people are living with multiple conditions at once, which is obviously more complex to manage. And honestly, we're looking at a shortage of about 8,800 GPs by 2031, which is quite alarming. A lot of doctors are leaving general practice because of burnout and just overwhelming administrative work.

What worries me is the knock-on effect this creates. When people can't get GP appointments, they wait longer, conditions get worse, and then they end up in A&E with things that could've been sorted out much earlier. It's more expensive and worse for patients.

I think we need to look at things like better recruitment and retention for GPs, making use of pharmacists and nurse practitioners more effectively, and yes, digital consultations where they make sense. But fundamentally, we need to value primary care more because it's really the foundation of the whole NHS—it's where we prevent bigger problems down the line

• Obesity and Sugar Tax

The sugar tax or Soft Drinks Industry Levy was first introduced in 2018 to tackle childhood obesity.

Discuss the pros and cons to sugar tax and whether you think it has been effective.

The sugar tax, introduced in 2018, has successfully reduced sugar content in soft drinks and raised public awareness about health impacts. Revenue generated supports NHS services, aligning with prevention values.

However, it's had limited impact on overall obesity rates. Critics argue it disproportionately affects lower-income families, and manufacturers often substitute artificial sweeteners rather than reformulating healthily. It also only targets drinks, not the broader diet.

For me, I'd say it's been partially effective, but we need much more than this. We should be looking at restricting junk food advertising to kids, better food education in schools, and honestly addressing why some families struggle to afford healthy food in the first place. Prevention needs to be comprehensive, not just one tax on fizzy drinks.

• Junior Doctor Strikes

Junior doctor strikes have drawn an increasing amount of public interest and attention. Why did strikes happen and what are some ethical considerations that doctors face when going on strike?

The strikes happened because junior doctors have seen their pay cut by about 26% in real terms since 2008, and they're working unsustainable hours. There's a real worry that if we keep losing doctors because of these conditions, patient care will suffer in the long run.

pay restoration, shortage of specialty training places and poor working ocnditons leading to low retention.

The ethical side is really difficult. Doctors have to balance their immediate duty to patients with the bigger picture—if the workforce collapses because people are burnt out and leaving, that harms far more patients eventually. It goes against "do no harm," but sometimes you have to ask what causes more harm: striking now or staying silent and watching the system deteriorate?

"This is really conflicted for me. On one hand, if doctors can't strike, employers could exploit that - imposing unreasonable hours, cutting pay, or increasing pension contributions without consequence. Other civil servants can strike, so why not doctors? And not all strikes would cause disasters - closing a clinic delays care but isn't life-threatening.

But the counterargument is strong - emergency services can't strike without risking lives. Plus, doctors are well-paid compared to most people, so striking during austerity looks tone-deaf and damages public trust. Also, practically speaking, cancelled patients just get rebooked, making other days busier, so doctors end up working harder anyway without pay for strike days.

I think doctors should be allowed to strike, but only in extreme situations and only in areas that aren't emergencies."

• Postcode Lottery

What is the postcode lottery and how does it impact patients receiving care?

The postcode lottery refers to significant healthcare disparities based on geographic location. For example, ambulance response times vary from under 7 minutes in London to over 10 minutes in the South West, and maternal mortality rates differ dramatically between regions.

This completely goes against what the NHS is supposed to be about—equal access for everyone based on need, not geography. But in reality, patients in underfunded areas face longer waits, less access to certain treatments, and often worse outcomes.

It's creating a two-tier system, just based on accident of where you happen to live rather than how ill you are.

To fix this, we need standardized protocols across the country, funding allocated based on actual population needs and deprivation levels, and we have to address the wider issues like poverty and housing that affect health in the first place. Healthcare equity should be at the heart of how resources are distributed.

• COVID-19

Did COVID-19 lockdowns work and what impact did they have on healthcare?

Lockdowns did work in the sense that they slowed transmission and stopped the NHS from completely collapsing. We flattened the curve, which gave us time to build up ICU capacity and develop vaccines.

But they came with huge costs. We've got massive backlogs now in surgeries and procedures that were postponed. Cancer diagnoses were delayed, which will have consequences for years. And mental health, particularly for kids and vulnerable people, really took a hit. NHS staff were pushed to the absolute limit and many are still dealing with that burnout.

The inequalities got worse too—poorer communities had higher infection rates and suffered more economically.

I think lockdowns were necessary in that moment—they bought us time when we desperately needed it. But they've shown us we need more resilient healthcare systems, better investment in mental health, and pandemic plans that try to balance protecting public health with minimizing the other harm that comes from these measures.

• Organ Donation

Currently, how is organ donation managed in the UK and what are the considerations that are take into account when allocating recipients with organs?

Since 2020, we've had an opt-out system, so you're presumed to be a donor unless you've actively said you don't want to be. The idea is to increase availability because we've still got over 8000 people on waiting lists.

NHS Blood and Transplant manages allocation using pretty strict criteria—how urgent someone's need is, tissue compatibility, how long they've been waiting, and even geography because organs need to be transplanted quickly. It's about balancing medical need with fairness.

One thing that's interesting is that even with opt-out, families can still refuse donation, which is respected. There's this tension between saving as many lives as possible and making sure the system is fair to everyone.

The challenges are obvious—we don't have enough organs, and finding good matches is difficult. We need better public awareness about the opt-out system and continued improvements in matching technology.

Ultimately, the system tries to be transparent and evidence-based so organs go where they'll do the most good while still respecting people's choices.

• Ageing Population

What is an 'ageing population' and what sort of impact will it have on the healthcare service?

An aging population basically means we've got more older people because we're living longer and having fewer babies. By 2030, one in five people will be over 65.

This has a massive impact on healthcare because older patients usually aren't dealing with just one thing—they've got multiple conditions that all interact with each other. We're seeing much more demand for geriatric services, people staying in hospital longer, and a huge need for social care support.

The big challenges are funding, not having enough geriatricians, and this frustrating gap between the NHS and social care—which is why you get people stuck in hospital beds when they're medically ready to leave but have nowhere appropriate to go.

I think the solution has to involve keeping people healthier for longer through prevention, developing community services so people can stay at home safely, and actually integrating health and social care properly instead of keeping them separate.

At the end of the day, it's about dignity and seeing the whole person, not just a collection of medical problems.

• Brexit

How has the 2016 Brexit referendum impacted the health service?

Brexit's had a pretty significant impact on the NHS. The biggest issue is workforce—we've lost a lot of EU healthcare workers, especially nurses, which has worsened existing staff shortages and increased pressure on teams.

There've also been supply chain disruptions affecting medicines and medical equipment, creating occasional shortages that impact patient care.

On the research side, it's made collaboration with EU countries more complicated, which could slow down medical innovation.

To address this, we need to focus on training and retaining domestic staff, maybe improving working conditions to make the NHS more attractive. We also need robust supply agreements and to maintain research partnerships globally, not just with Europe.

It's shown how vulnerable the NHS is to external pressures and why we need adaptable, resilient systems.

• Sustainability

Can you discuss the main challenges the NHS faces in becoming more sustainable, how might these be addressed, and how does the topic of sustainability impact healthcare?

The NHS produces 4% of the UK's carbon emissions, so there's a real push to hit net zero by 2045.

The main challenges are cost—green technology and building upgrades are expensive upfront—and the sheer scale of changing such a massive organization. There's also resistance to change and balancing sustainability with immediate patient care needs.

We can address this by starting with quick wins like reducing single-use plastics, switching to renewable energy, and encouraging digital consultations to cut down on travel.

Sustainability actually impacts healthcare directly—climate change worsens air quality, increases heat-related illnesses, and spreads diseases. So by going greener, we're protecting future patient health while cutting long-term costs.

It's about thinking beyond today's patients to the health of future generations.

• HIV and PrEP

Do you agree or disagree that PrEP for HIV should be widely available? Discuss the controversy surrounding this topic.

I definitely think PrEP should be widely available. It's incredibly effective at preventing HIV and could massively reduce transmission rates, especially in high-risk groups.

The controversy's mainly around cost and whether it encourages riskier behavior. Some worry people might stop using condoms, but evidence shows that doesn't really happen—and even if it did, preventing HIV is worth it.

There's also the stigma issue—some communities still don't know about PrEP or feel uncomfortable accessing it because of judgment around sexual health.

I think we need better public education campaigns to normalize it, tackle the stigma head-on, and make sure everyone who needs it can actually get it. Prevention's always cheaper than treating HIV long-term, and it fits perfectly with the NHS focus on equity and public health.

• Vaccination Mandates

Uptake of COVID-19 vaccines during the pandemic was met with controversy. Discuss the controversy that could arise from having vaccination mandates.

Vaccination mandates are really tricky. On one hand, healthcare workers have a duty to protect vulnerable patients, and vaccines massively reduce transmission—so there's a strong public health argument.

But forcing people creates huge issues. It violates bodily autonomy, which is a fundamental right, and during COVID it risked losing staff we desperately needed, making shortages even worse.

There's also the trust issue—mandates can fuel conspiracy theories and make people more resistant, whereas education and open conversations usually work better.

I think instead of mandates, we should focus on tackling misinformation, making vaccines easily accessible, and having honest discussions about concerns. Most healthcare workers want to protect patients—it's about addressing their worries rather than forcing compliance.

Balance is key—patient safety matters, but so does respecting people's choices.

• Global Warming and Impact on Health

What are some of the impacts global warming will have on global health?

Global warming's already having massive health impacts. Rising temperatures are causing more heat-related illnesses, especially in vulnerable groups like the elderly. Air pollution from climate change is worsening respiratory problems like asthma.

We're also seeing diseases spread to new areas—things like malaria moving into regions that were previously too cold. Extreme weather events cause injuries, disrupt healthcare access, and damage infrastructure.

Food and water security are huge issues too—droughts and floods affect nutrition and increase waterborne diseases, hitting low-income countries hardest.

The NHS needs to prepare by building climate-resilient healthcare systems and reducing our own carbon footprint. But really, it needs global cooperation—richer countries have caused most emissions but poorer ones suffer the worst health consequences.

It's basically a massive equity issue that links environmental action directly to patient care.