Medicine interview- NHS

What do you think of the state of the NHS? What challenges does it face?

​Both currently and in the past, the NHS has faced obstacles in delivering healthcare to the UK population, via a method that is 'free to all'.

Challenges such as the increasing population size of the UK - alongside the development of an ageing population have meant that the NHS has had to adapt to the best of its ability

although it is not perfect, I do believe that the NHS is nonetheless an effective healthcare service that is accessible to all members of society,

compared to systems such as that in the US.

What would you do to improve the state of the NHS? What is a prevalent issue?

there are certain changes I would implement.

For example, one issue that is prevalent is the lack of funding to mental health services.

There has been a significant rise in mental health presentations to primary and secondary care in the past 10 years

however the services available have not been able to match this increased demand.

Thus, I would support more funding going into clinics and facilities providing support for patients with mental health disorders.

What single healthcare intervention do you think could change the health of the UK population the most?

I believe that advising patients about lifestyle changes such weight loss and a balanced diet to a greater extent could dramatically change the health of the UK population with minimal capital expenditure.

Obesity and diabetes are two conditions that have seen a drastic increase in recent years, and have significant financial and social costs.

How much does the NHS spend on diabetes and obesity related issues?

around £10 billion per year on diabetes, and in 2014 spent £6.1 billion on overweight and obesity related health illnesses

What is one reason for the high cost?

the secondary conditions that can result from these diseases, such as kidney failure, blindness, bone disease and neuropathies.

Both diabetes and obesity are conditions that could be mitigated by alterations to the lifestyles of at risk groups,

thus I feel that launching initiatives aimed at encouraging dietary changes and weight loss would have marked benefits on the UK population.

What are the main differences between public and private healthcare in the UK in relation to funding and availability ?

public healthcare= funded by taxation and is thus accessible to all UK residents

private healthcare= users pay the actual companies providing the services or an insurance provider, meaning that only those who are able to afford it can utilise it.

What is the differences in services provided by private and public healthcare?

Public healthcare covers most treatments and procedures,

however services such as eye tests and dental care are not provided.

Private healthcare, on the other hand, supplies the services that are not provided by the public system, often at a higher cost but at a faster rate.

Despite this, it must be noted that certain treatments are often not covered by private insurance; these may include organ transplants, cosmetic surgery and chronic illnesses.

Why do some people describe the NHS as the 'jewel in the welfare crown'?

​Welfare plays a pivotal role in the UK, with the welfare state covering health, education, employment and social security. The use of the term 'welfare crown' encompasses these services, and describing the NHS as the 'jewel' suggests that it is as being precious and valuable, but also resilient and durable.

Why is the NHS extremely valuable to the uk?

being able to provide healthcare that is 'free' to the point of delivery, and without it great numbers of people would be unable to access even the simplest forms of healthcare.

It has also shown itself to be resilient, having lasted for greater than 70 years to date, despite the vast political and socioeconomic changes that have occurred in the UK.

What is the NHS postcode lottery?

term used to describe differences in the availability or quality of healthcare, as a result of where patients live or are located.

These variations exist as a result of Clinical Commissioning Groups (CCGs), which are membership bodies that decide which services are required by their local areas. As the needs of each region differ due to factors such as the patient demographic, the care available fluctuates between neighbouring areas.

Services that are affected by this range from screening and diagnostic procedures to major operations;

for example, it was found that outcomes from CT colonoscopies for bowel cancer were contrasting between two certain adjacent commissioning groups, which consequently affected the number of patients that were able to receive treatment for this disease.

What are the main challenges faced by the NHS in England?

Whilst there are shortages of certain healthcare staff in England - for example, nurses and GPs - currently a major concern is the long waiting times faced in A&E, with it being the worst in 15 years.

As a result of the increasing population size and thus a greater demand on A&E services - in addition to many of the patients being older and thus having a greater number of co-morbidities - people visiting the emergency services are often unable to receive urgent care, which can be detrimental particularly during the winter months.

If you were the Secretary of State for health, what two changes would you make?

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If I was the Secretary of State for health, the two issues I would tackle the deficit in the number of nurses working for the NHS, and increase the proportion of funding that goes to treating mental health conditions.

Despite there being a dramatic rise in the prevalence of mental health disorders, NHS funding has not been able to meet this demand, with many young people in particular being unable to receive the necessary treatment.

Therefore, I would utilise such funding to increase the number of mental health clinics across the UK, and ensure that staff had the appropriate training to identify and diagnose patients.

If you had to reduce funding to two areas of the NHS, which areas would you choose?

The first area of the NHS that I would reduce funding to would be on building developments.

Whilst I do believe that patients should be treated in a warm and welcoming - and aesthetically pleasing - environment, I also feel that funding should be prioritised in areas that are directly imperative to patient care, a key example being the recruitment of staff.

A crucial aspect of patient care is the rapport that they have with healthcare professionals - nurses in particular - which I believe is more important than the environment that patients are in.

What is another area?

The second domain in which I would reduce funding to would be cosmetic surgeries that are covered by the NHS, such as breast reduction or implants. I understand that these procedures are carried out for psychological and often physical reasons, however I would want to prioritise life-threatening and urgent surgeries, such as cardiac and neurosurgical cases.

What does the significant shortages of nurses impact?

not only impacts the quality of patient care because of the pivotal role nurses play in attending to patients' needs, but also for the reason that less qualified staff, such as healthcare assistants, have been enlisted to help meet the demand in care.

I believe that a way to rectify this would be to encourage more young people to enter the nursing profession through launching nationwide initiatives; this could be achieved by providing pupils with work experience in a healthcare environment, for example, to stimulate an interest in this field. Additionally, reinstating funding for nurses in training should also be considered.

Outline the pathway after medical school to become a GP? And compare this to the pathway to become an Orthopaedic Consultant

After graduating from medical school, students are provisionally registered with the GMC, before starting their two foundation years (they obtain full GMC registration after FY1).

These two years involve rotating around different hospital departments, with Foundation Year 2 often being focussed on specialties such as general practice, emergency medicine, paediatrics and psychiatry, to name a few.

After these foundation years, to become a GP junior doctors will enter a general practice vocational training programme for 3 years.

To become a consultant, all junior doctors will participate in the two foundation years; however, the route after this training differs between GPs and orthopaedic consultants.

After completing the FY1 and FY2 years, junior doctors instead undergo 8 years of speciality training to become an orthopaedic consultant.

This 8 years involves three phases; the first phase consists of rotations in general surgical specialties (for example, cardiac and vascular surgery as opposed to just orthopaedics), the second encompasses higher specialist orthopaedic training, and the third entails subspecialty experience (this can be undertaken in the UK or in some cases abroad).

​Do you consider the '7 Day NHS' a step forwards, and why?

There are both advantages and disadvantages to this policy.

In particular, whilst it intends to enhance patient care, I feel that there are potential negative consequences, particularly on NHS staff.

This policy was implemented for numerous reasons, but the most significant was due to the supposed poorer quality of care received by patients on weekends, as opposed to weekdays. This claim suggested that this was because of reduced numbers of staff working on weekends, resulting in the plan to extend the working week to 7 days.

Other changes involved in this scheme include the provision of urgent care for 24 hours a day, and an increased access to GPs, to reduce the pressure placed on emergency services. However, despite this attempt to improve healthcare access for patients, one consequential cause for concern is whether the funding is available for such a service.

Furthermore, as NHS staff across the UK would be required to work for more prolonged lengths of time, there could instead be a decline in the quality of patient care provided, as healthcare professionals are placed under increasing stress.

For this reason, although I do understand and agree with the objectives of the 7 day NHS, I do not believe it will be financially sustainable in the long run, and may have harmful effects on patient care.

Explain the following two NHS policies; 'Two Week Wait Pathway' & 'A&E Four Hour Target'

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Two Week Wait Pathway

The Two Week Wait pathway is a referral pathway in which a General Practitioner requests an appointment for a patient with a secondary care specialist where there is a suspicion of cancer and the patient should be offered an appointment within 2 weeks of the request being made. This policy exists in England, but not in Scotland and Wales. In Northern Ireland, it is utilised only if a patient is suspected of having breast cancer.

Four Hour Target

The four-hour target is a strategy that has been implemented to reduce waiting times in A&E. It states that at least 95% of patients in A&E should be admitted, transferred or discharged from A&E within four hours.

The NHS should embrace privatisation; to what extent do you agree with this statement?(pos.)

​When discussing this statement, it is important to consider the reasoning for it and reflect on the potential advantages of privatising the NHS.

A key reason for why this could be beneficial is because the NHS is currently under a significant amount of financial strain; factors such as the increasing UK population size - and the fact that it is ageing - have meant that NHS spending has expanded dramatically in recent years.

Furthermore, certain conditions that take up a high proportion of NHS expenditure, such as diabetes and obesity, have grown in prevalence drastically. A private healthcare system could help rectify this, by distributing patient care across different companies and providers, not only relieving the financial pressure but also aiding the high influx of patients experienced at A&E in particular.

The NHS should embrace privatisation; to what extent do you agree with this statement?(neg.)

However, despite these arguments, I believe that privatising the NHS could have negative consequences and should not be implemented. Privatising healthcare could threaten the quality of patient care; ultimately these companies would be motivated by financial gains as opposed to patient satisfaction, and so would value quantity over quality to ensure a maximum profit is made. Another outcome of private companies prioritising economic benefits is that they would cover services providing the greatest financial rewards, potentially resulting in a gap in services requiring urgent funding, such as mental health.

For this reason, although privatisation could help the NHS financially, it could also significantly compromise patient care, which I believe should be the healthcare service's prime concern and should be protected at all costs.

Should the childhood vaccination schedule be made compulsory?

When discussing this topic, an important consideration is that patient autonomy should be respected, and through making childhood vaccinations compulsory, the autonomy of the child - or the guardian of the child - could be threatened.

Often the reasoning for choosing to not have children vaccinated is the potential side effects of vaccines. For example, the flu-like symptoms such as a fever and chills or the (arguably irrational) fear of the children going on to develop the disease that they are being vaccinated against. Although such an opinion is not factually correct, parents of these children do have the right to decide against vaccinations, and thus it could be argued that their decision should be respected.

However, it must be argued that withholding childhood vaccinations could have detrimental consequences. Childhood vaccinations protect against diseases such as polio, tetanus and measles, mumps and rubella.

These conditions can be fatal - measles is particularly dangerous and has a high rate of mortality in children - therefore preventing these vaccinations could place infants in greater danger than if they had the vaccine. For this reason, I believe that childhood vaccinations should be compulsory, as they provide children with a high level of protection against diseases that can be life-threatening.

Should doctors be paid more to work to work in rural areas?

Rural areas in the UK often receive a different quality of healthcare compared to urban areas. Due to factors such as long distances for patients to travel and a difficulty to recruit and retain staff, patients in these areas often do not receive an optimal level of care, and may have to wait extended periods of time for routine health procedures as well as emergency interventions. For this reason, to encourage healthcare professionals to work in rural regions, it may be advantageous to pay them greater amounts to improve patient care.

However, there are potential risks of this idea. Firstly, given the fact that the NHS is currently under significant financial strain, such a policy could place it under more pressure, due to it being particularly expensive to increase doctors' pay, especially on a nationwide scale. Secondly, whilst this scheme may improve waiting times, it may not necessarily improve patient accessibility to services. It must therefore be considered whether this policy would be worth the high cost, if such a significant obstacle in providing healthcare to patients would still remain. Finally, it may be argued that this costly proposal may address an issue in one geographic area, and merely create shortages in other (non-financially incentivised) areas.

What is your opinion of the current organ donation policy in England?

Presently in the UK, there is an 'opt-in' organ donation policy. This means that people are not automatically assumed to be donors, but instead can choose to donate their organs should they wish to. Ethically, this policy appears justified, as it provides individuals with the choice of whether they want to become donors, and ensures that consent has been given. It also makes sure that people who may not be aware of organ donation for example due to a lack of education - do not have their autonomy breached by unknowingly being donors.

However, despite this I do believe that an 'opt-out' organ donation policy would be beneficial. There is currently a deficit in the number of donors available - with many patients spending several years on waiting lists - resulting in high levels of morbidity and mortality. Additionally with a greater supply of organs, the likelihood of 'exact matches' would be much higher thus reducing organ rejection rates.