NHS Hot Topics 2017-18
If you’ve started your interview preparation, you’ll know that NHS hot topics are a key part of a medical school interview. So it’s important that you know your news!
This page will recap a couple of key medical hot topics for 2017-18. This is by no means exhaustive, just a selection of big news stories in medicine this year, from the impact of Brexit on healthcare to the Charlie Gard case.
For an idea of how to approach NHS hot topics in an interview, visit the NHS Hot Topics section of our Interview Question Bank.
NHS Hot Topics 2017-18: The Impact of Brexit
In a nutshell:
How Brexit may affect UK healthcare is one of the key NHS hot topics of 2017-18. It would have been pretty difficult to avoid hearing about Brexit over the past year – so it’s likely you already know a lot about it already! However, to briefly recap: on 20th February 2016, the then Prime Minister David Cameron announced that the British public would vote to decide whether the United Kingdom should remain a member of the European Union.
On 24th June 2016, Britain declared it would be leaving the EU. With the exit process still underway, it will be years until we can quantify the full effect of Cameron’s referendum, but for the medical profession, financial, staffing, and research concerns are set to continue for a very long time.
How might Brexit impact healthcare?
- The Nuffield Trust published findings that despite the additional challenges Brexit will bring about, it is possible that the government will allocate an extra £100m per week to the NHS – a budget increase of 4%. The effects of an economic recession on this figure are unclear.
- Since the result of the referendum, there has been a 96% reduction in the number of nurses from overseas EU nations applying for work in the NHS.
- Despite currently having over 60,000 European workers in the NHS already, the lack of new migrant workers has left the NHS with a real terms loss of 40,000 nurses.
- This number is expected to fall further once Britain fully leaves the European Union, when harsher immigration laws are implemented, the value of sterling and UK salaries decrease, and the recent drive for a ‘seven day NHS’ deters EU staff from signing up for longer hours.
- The other major area which will suffer in the wake of the Brexit result is the impact on scientific research if the UK is unable to retain its EU funding.
- Between 2007 and 2013, the UK contributed €5.4bn to the European science budget but received over €8.8bn – a €3.4bn EU-sourced surplus far from the pro-independent rhetoric of the Leave campaign.
- Similarly, the free movement of specialists both into and out of EU member states that the UK currently enjoys may be revoked, or more heavily sanctioned.
NHS Hot Topics: What I might be asked about Brexit?
- How do you think Brexit might impact healthcare in the UK?
- Do you think Brexit is a positive or negative for the medical profession?
NHS Hot Topics 2017-18: Charlie Gard Case
In a nutshell:
This is another one of the key NHS hot topics of this year. Charlie Gard was born on 4th August 2016. After a month, his parents noticed that he was struggling to support himself. He was transferred to Great Ormond Street Hospital – and in November 2016, doctors identified his condition as infantile onset encephalomyopathic mitochondrial DNA depletion syndrome (MDDS). This caused Charlie severe organ failure and he survived for 11 months with the support of a ventilator.
What treatment was offered to Charlie Gard?
- After advice from UK doctors and a ruling from the High Court recommending Charlie’s life support be discontinued, American neurologist Dr Michio Hirano offered Connie Yates and Chris Gard a chance to continue treatment of their son.
- The process he advocated was nucleoside bypass therapy, untested on either humans or animals with MDDS, and Charlie’s parents raised the £1.3 million needed for the treatment.
What were the legal issues surrounding the Charlie Gard case?
- In situations where the doctors and parents cannot agree on the best treatment for a child, the case is presented to the High Court. They ruled that it was in Charlie’s best interests to withdraw his life support.
- Charlie’s parents also appealed to the European Court of Human Rights, but it was concluded that undergoing experimental treatment with ‘no prospects of success… would offer no benefit’.
- Charlie Gard’s life support was duly removed and he died on the 28th July 2017, at 11 months old.
What were the ethical issues surrounding the Charlie Gard case?
- In this situation, Charlie’s parents acted on his behalf, choosing to pursue treatment.
Distributive justice (the expected benefit is insufficient to justify the public resources used)
- The National Institute for Health and Care Excellence (NICE) recommends treatment at a cost of £30,000 per Quality Adjusted Life Year (QALY) or less.
- Whilst the nucleoside bypass therapy was relatively inexpensive, the cost of ongoing intensive care was estimated at £150,000 – and Dr Hirano’s best possible outcome was a 10% chance of giving Charlie a shortened lifespan with a severe disability.
- Estimating the quality of Charlie’s potential adulthood life at 0.3 – of a possible 1.0, due to the severity of his disabilities, over a fifty-year lifespan, results in 15 QALYs. The likelihood of this occurring, however, was estimated at only 10%, reducing the QALYs to 1.5. At a cost of £150,000, the cost per QALY for Charlie’s treatment was £100,000 – over three times the advisory limit.
- However, the money for the therapy was raised privately, and as such, the funds for Charlie’s care were ineligible for redistribution to other causes. The legitimacy of the distributive justice argument is therefore highly dubious under the circumstances.
- The High Court concluded that the chance of success was too low to justify the trauma that Charlie may have experienced as part of the treatment, and that a successful procedure wouldn’t have yielded a sufficient quality of life.
- The decision was, of course, highly controversial. Dr Hirano, for one, argued that the alternative to ongoing treatment and care was certain death, and that a slight chance was better than none.
- This argument then raises the question of where the threshold for what is worth attempting should lie – even a 0.1% chance of success equates to a saved life for every thousand cases. Ignoring the statistics, many question whether one can ever declare another human being’s life worthless.
NHS Hot Topics: What might I be asked about the Charlie Gard case?
- What are the ethical issues surrounding the Charlie Gard case?
- Should doctors or parents decide on the best treatment for a child?
- Should patients have the right to experimental treatment?
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NHS Hot Topics 2017-18: 7 Day NHS
In a nutshell:
You will have read a lot in the news about the seven day NHS. A study found that a patient is 15% more likely to die if they are admitted on the weekend than if they are admitted mid-week. The government wants to prevent these deaths by ensuring that weekend services are available at the same standard as weekday services.
What are the issues with the 7 Day NHS?
- Pay: to provide non-emergency services over the weekend, current medical staff will need to work additional hours, for additional pay, or the NHS needs to employ more staff – and many doctors are unclear on what Mr Hunt’s policy will mean in practice and where this money will come from.
- Morale: if the government decides to simply increase targets and workloads without sufficient remuneration, burnout, resignations, and a drop-off in medical school applicants will become a major issue.
What will happen next?
- The government is currently taking part in negotiations with the British Medical Association (BMA), who do not currently support the scheme.
- If the BMA will not negotiate, the government is prepared to impose these changes, and won’t allow the BMA to act as a roadblock to reforms that will save patients’ lives.
- There have also been plans to extend GP surgery opening times, with Theresa May pledging £528m per annum to ensure that all surgeries are open from 8am to 8pm by 2021, unless they can prove a lack of demand from the public.
- There is an ongoing debate between Stephen Hawking and Jeremy Hunt about the seven-day NHS, with Hawking passionately declaring his deeply personal investment in the future of the health service.
- Hawking blames political decisions such as underfunding, privatisation, the new junior doctor contract, and the removal of the student nurses’ bursary for the current NHS crisis – and not the provision of services.
NHS Hot Topics: What might I be asked about the 7 Day NHS?
- What do you understand by the term ‘7-day NHS’?
- Is implementing a 7 day NHS a positive – and if so, why?
- What do you think are the major challenges involved in implementing a 7-day NHS?
NHS Hot Topics 2017-18: Junior Doctors’ Contract
In a nutshell:
You will have already read a lot about the junior doctors’ contract in the news over the past year. The controversy began in 2013, and has divided both the public and the media. The Department of Health introduced the contract with the intended aim of making pay fairer, and the end goal of spreading both emergency and elective services across seven days of the week.
What is the new junior doctors’ contract?
The government is changing the contracts following recommendations made by the Review Body on Doctors’ and Dentists’ Remuneration. They have set out six criteria that will guide their recommendations:
- Improving patient care
- Maintaining respect and trust for consultants and junior doctors as leaders and professionals
- Credibility and practicality of local implementation
- Appropriate remuneration to recruit, retain and motivate
- To help facilitate constructive, continuing relationships
Pay and hours
The system of pay and hours will also be overhauled in the new contract. There are now four points of nodal pay along the training cycle.
|Level of Responsibility||Nodal Point
|Foundation Year 1||Nodal Point 1
|Foundation Year 2||Nodal Point 2
|Specialty/Core Training 1, 2, 3||Nodal Point 3
|Speciality/Core Training 4,5,6,7,8||Nodal Point 4
The time-served concept is abandoned, and the basic pay packet is now linked only to the level of responsibility held. Basic pay itself has increased by 10-11% but is now determined by on-call and weekend allowances, with no banding system in place.
Depending on how many weekends a doctor works, and their nodal level, they are awarded an extra percentage of their allowance – for example, junior doctors who work one in every two weekends will get an additional 10% of their basic pay, whilst those who only work one in eight weekends will get 3%. On-call allowances follow a similar concept, where extra pay is based on the nodal point.
What are the issues with the new contract?
- The British Medical Association (BMA) has raised several concerns over certain points of the proposed contract – such as rota shift patterns and pay.
- The main concern is the impact the additional weekend and night shifts will have on patient care – the new rotas are designed for a seven-day NHS, but do not account for additional staff.
- Many junior doctors have concerns that the new contract will increase stress, tiredness, and burnout among their peers, and that patient care will suffer. As a result, junior doctors have overwhelmingly voted for industrial action, culminating in walk-out strikes.
What are the consequences of the new contract?
- The new contract is the result of multiple negotiations between the BMA and the Department of Health.
- In November 2015, junior doctors voted in favour of 98% to reject the contract and were in favour of industrial action – which led to a series of strikes.
- The issue is still ongoing. NHS Employers, the human resources arm of the Department of Health, have plans to roll out contracts to different specialties in phases over the next year.
NHS Hot Topics: What might I be asked about the junior doctors’ contract?
- Can you explain the recent issues with junior doctors’ contracts?
- What are the major changes proposed in the new junior doctors’ contract?
- Would you have gone on strike / were people right to go on strike?
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NHS Hot Topics 2017-18: Mental Health Services
In a nutshell:
Mental health services in England currently deal with a range of conditions, including anxiety, depression, eating disorders, obsessive compulsive disorders and psychosis. One in three people experience mental health problems while in employment – and recently the NHS has worked to increase much-needed funding for mental health services.
What are the challenges facing mental health services?
- Funding of mental health services is often in the public eye as many patients are frequently unable to get a bed in a mental health hospital close to their homes.
- According to NHS figures, almost 6,000 mental health patients were sent far out of their local area to receive care – a rise of 40% in just two years.
What is being done to improve mental health services?
- NHS England is aiming to develop and implement a new national programme for mental health by 2020, for which the government has pledged £1.25 billion. These improvements will reduce the number of patients who are forced to travel miles to their nearest mental health hospital. NHS funding will enable them to use their local services.
- Part of this plan includes supporting Clinical Commissioning Groups (CCGs) to improve mental health for children.
- Jeremy Corbyn, leader of the Labour Party, recently appointed the first ever Shadow Minister of Mental Health, stating that he wanted to place mental health on par with physical health.
- Simon Stevens, the Chief Executive of NHS England, said: “One in four of us will suffer from depression, anxiety or other mental health problem, but mental health services have historically been the NHS’ poor relation. Putting mental and physical health on an equal footing will require major improvements in seven day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered.”
NHS Hot Topics: What I might be asked about mental health services?
- Is mental health an area of concern for the NHS – and if so, why?
- Do you know of any of the challenges facing mental health services at the moment?
Looking for More NHS Hot Topics?
We’ve started a blog series on 2017-18 medical hot topics. You can read more below: