What single healthcare intervention could change the health of the UK population the most
Alzheimers disease is becoming more and more common. When volunteering in the nursing home I was able to see it first hand how it can drastically change someones life. In particular I often found myself going through old photos with some patients, who would struggle to name the people in the pictures, and could get quite frustrated.
I believe a lot more funding should be put into understanding how it works as currently some specialists believe it is the build up of proteins in our brains that disrupt neurological processes. If we gain a better understanding of the disorder hopefully a cure to it could be discovered which I think will change the health of the UK’s population the most.
In particular:
- Earlier screening so everyone over the age of 65 has to do an appointment to catch early signs of it:
Benefits: Gives families more time to prepare, earlier lifestyle or medication habits
- Look into risk factors: Addressing these can prevent 40% of cases
- Eg promoting cognitive stimulation, stop smoking, more physical activity
- Investment into research, so things that target those protein build ups.
Neuroprotective agents.
Slowing disease progression - Improve standard of care for those patients so more support for families, training for caregivers.
- Public health campaigns to reduce stigma around Alzheimers and encourage people to get screened for it.
What is a current problem in the NHS
. When doing work experience in St Mary’s hospital I found a continuous issue where there weren’t enough beds for patients. This is partly because many of the patients didn’t actually have homes as they had been in the hospital for so long, so despite them being healthy enough to be discharged they had nowhere to go so were staying in the hospital and taking up beds that could be used for more seriously ill patients.
. So more funding should be put into social care to alleviate this pressure off the NHS so it is working strongly again.
When should problems in a healthcare setting be reported to higher authority?
- The GMC states that all doctors have the duty to raise concerns if patient safety or care is being compromised.
This could be due to staff or systems. - So if a patient could have been harmed, or has suffered a level of harm
- It is important to create a work environment where healthcare professionals feel confident enough to come forward about a problem.
- An example of this could be the Francis report, where in the Staffordshire hospitals where patients were being neglected. It was found that staff were being mean and not treating them with enough respect. In this situation I assume there must have been some whistleblowers, who took a big chance drawing attention to this by reporting it to higher authority. Without this, the level of care could still be like that today.
Why is confidentiality important
The GMC states that doctors have the ethical and legal duty to protect patients private information from disclosure.
A doctor-patient relationship is built on trust and respect so I think it is incredibly important that the patient knows that the information they have given to the doctor won’t be spread around. This could lead to a compromise of patient care, and also less people would want to visit a doctor if they’re afraid of this happening.
Bring up Harold Shipman case as confidentiality had to be breached to find evidence to arrest him.
NHS staffing shortage information
- Estimated that the NHS is currently short 154000 staff
- If you compare the number of people per doctor in the NHS the number is a lot higher than in many countries in the EU
. This is a problem because less people will want to go into the healthcare profession and we will see more workers leaving it.
Not only that but these vacancies in hospital wards means that the current doctors and nurses are having to do this extra work to make up for the lack of workers. So will become more stressed and they can be burnt out which would compromise patient care.
Why is the NHS understaffed
- It costs around £500000 to train a consultant, and around £60000 to train a nurse.
This means that the government need to be cautious when selecting doctors and nurses to enter as they don’t want to have too many which would use a lot of money - Insufficient use of foreign recruitment: 1 in 3 doctors were trained outside the UK. So the NHS relies heavily on migration, however new policies may make it difficult for foreign doctors and healthcare professionals to come and join the NHS
- It is difficult to understand how many nurses and doctors we need for each sector of medicine as it is constantly changing. It takes around 15 years to train someone to become a consultant.
Also due to AI the field is ever changing so difficult to estimate what we will need in 15 years time when the current medical students become consultants
What is the government’s 2024-2025 priorities to address this staffing problem
In 2024- 2025 the priority is to recover our core services and priorities following the pandemic.
Particularly maternity and neonatal sectors.
. Improve ambulance response and A&E waiting times to support admissions and hospital discharge
. Reduce elective long waiting lists
. Improve performance for diagnosing cancer
. Make it easier for people to access community healthcare such as dentists and GPs
. Improve access to mental health services so people of all ages receive the treatment they need.
What is the long term plan
. Shorten medical school degree to 4 years so it is more appealing to get more applicants to study medicine
. Increase number of medical school places and nursing places
. Increase number of nursing and physician associates
Junior doctor contracts
Junior doctors feel that they are undervalued and underpaid in the NHS.
Funding cuts have led to them going on strike.
In 2015 they went on the strike and in 2018 the government agreed to give them a 2% pay rise year on year, however since inflation this is no longer enough to support them and the loss in value means their pay is falling.
DDRB ( Doctors and Dentists Review Body) is meant to advise the government on what the NHS needs.
Junior doctors think the government is pressuring it to advise them what the government can afford but not what is needed.
Government don’t want to pay junior doctors any more than they are financially able to afford.
LINK TO WORK EXPERIENCE
3 reasons junior doctors are going on strike
- To get their pay restored to full levels in 2008 before it became eroded by inflation
- They want to agree a mechanism to stop this problem happening again in the future so their level of pay isn’t eroded again
-They want a full review and reformation of DDRB which is meant to be independent
Who is Harold Shipman
He was a serial killer doctor who murdered his patients.
He was a GP in yorkshire
In the 80s and 90s he murdered 250 patients
Who and how did he murder
He built up good relationships with vulnerable patients for example elderly women.
He would go to their homes on visits then murder them by injecting a very strong painkiller which stopped them breathing
He was known to forge their wills so he could get money
Why is this case important
Society and communities put loads of trust into doctors and he completely abused his power
It has led the public down a more autonomous route so they have a say in what is put into them
What is the Francis report
It looks into care failures in the mid Staffordshire NHS foundation trust which had two hospitals
First came to light in 2009
- It included patients being stripped of their dignity eg being left in a pool of their own faeces and urine
Or being left naked on a bed with the door open - Staff being rude to patients and their families
- Staff covering up patient falls and failings in their care
Many people unnecessarily died as a result
This Francis report was published in 2013 and looked into the reasons behind this
Why is this important
It is horrible that this treatment was able to go on for so long, and shows how things can go very long.
Why was it allowed to go on?
Senior managers and staff ignored concerns brought to them from patients and staff members.
People whistleblowing were ignored
Reasons for the staffordshire trust scandal occurs
- Managers were more fixated on numbers rather than the patients themselves and their experiences
- The staff were obsessed with the hospital becoming a trust to gain more status and authority to get more money for their services
- Understaffing eg ratio of nurses and assistants. So it is very difficult to deliver top quality care if you are understaffed and the workers will have to work longer hours and they will be burnt out.
Main themes as a result of the scandal
- Listening to people whistleblowing, so now we have freedom to speak to a guardian eg PALS in the hospital to address their concerns.
That role is responsible for getting that complaint heard, and say it to senior managers who have a duty to listen - Openness: Culture can influence peoples actions so staff and patients need to have a better relationship.
So healthcare professionals don’t only focus on targets
Hadiza Bawa Garba
- In 2015 this paediatrics trainee doctor was found guilty for negligence of a 6 year old boy with down syndrome and a heart condition called Jack Adcock
- She was a trainee so was supposed to be accompanied by a senior consultant paediatrician but that day the hospital was very short staffed so the consultant wasn’t there to help her.
- The patient had diarrhea and was vomiting and she thought it was dehydration or an upset stomach. She still ordered bloods and chest x-ray but there was an IT problem so she couldn’t see them for hours.
She finally saw them and gave him antibiotics for chest infection, but there was a delay in treatment.
In addition to this he was dehydrated so a usual medication he takes was taken off his chart as it dehydrates you but a nurse still let the mum give it to him
Then Jack was moved into a side room in a different ward without the Doctors knowledge and in it was a sign saying do not do CPR because it was previously occupied by a terminally ill patient.
Called DNA CBR
So Jack Crashed that evening and goes into cardiac arrest but the nurses and doctors took a while to realise they should do CPR and it was jack and not the other patient
He died from Sepsis
- She was treated terribly by her colleagues, seniors, courts, GMC (general medical council) after the event
Why is this case important
Although Dr Bawa Garba did make mistakes, she was scapegoated for the case and was blamed for everything that happened.
Even though it was systemic failings that caused this she was struck off from practicing medicine.
It also could allude to a racism problem, as black doctors are disproportionally referred to GMC.
They are prosecuted a lot for gross negligence manslaughter
Charlie Gard Case
Infant boy from London who died at age 11.
It is important because it highlights what happens when doctors and families disagree over treatment
- He was born with rare genetic condition so he was failing to grow properly and thrive
- There is currently no treatment for this genetic condition but at the time there was an experimental treatment being made in NY
Charlie had a series of fits which meant no oxygen could reach the brain so his condition was significantly deteriorated
So the hospital decided the experimental treatment in NY would NOT be beneficial and decided to let him die peacefully.
But Charlies parents wanted to do the treatment so started gofundme. Parental rights over the child came into play however the doctors went to court against them and court decided to let him die peacefully
And so he died
Why is Charlie Gard case interesting
It looks into autonomy and the clashes it can have with maleficence or beneficence.
Young children can’t tell doctors what they want so the parents have the right.
Shows the problems that arise in the NHS between parents and doctors clashing opinions.
Head to head butting of media getting involved
What is the GMC
General Medical Council oversee medical training and education
The GMC released good medical practice in 2024, what does it say
Good Medical Practice sets out the expectations for the standard of care that all doctors on the register are expected to follow.
What 5 things does it state
- Create work environments that are compassionate, respectful and fair.
- Promote patient centred care so decision making is two ways of expertise as patients are experts of themselves
- Tackle discrimination
- Champion leadership that is fair and inclusive
- Support continuity of care and self delegation
