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NHS Hot Topics for 2018 to 2019 entry

Read a brief summary about the NHS hot topics that might come up in your interviews for the 2018-2019 cycle.
Published 11th Nov 2018

Introduction

At Medical School interviews, you may be faced with questions about current or recent issues relating to the NHS or health in general. That’s why as you prepare for your interviews, it’s important to learn about these issues and make sure that you understand them and could discuss them at an interview. We’ve put together this list of the main “hot topics” to read about for an interview in the 2018-2019 admissions cycle so that you know which news stories to focus on.

Brexit

A referendum was held in June 2016 and 52% of the British public voted to leave the European Union. Britain is currently preparing to the leave the EU on 29th March 2019. This will have massive implications on almost every sector, including healthcare, so this is a big topic that may be discussed at interviews this year. Think about things like:

  • 6% of all NHS staff are from the EU – that’s just over 1 in 20 members of staff. This includes 9.7% of all doctors and 6.8% of all nurses1. The potential loss of these highly-skilled and valued members of staff would be catastrophic to the NHS. A cut to the already over-stretched workforce would likely result in increased waiting times and a potential reduction in quality of care.
  • Reduced access to medication and medical equipment. Many medications dispensed in the UK are not manufactured in the UK. The active ingredients are often manufactured in other countries, then they are transported to a factory to be processed into a tablet or capsule. The finished product then has to be transported to the UK to be distributed to different hospitals and pharmacies. It’s a long and complicated process involving multiple countries outside of the UK, and Brexit may have significant impact upon this.
  • Barriers to clinical trials. There are not enough patients in the UK with rare diseases to take part in clinical trials. Previously data from the UK has been combined with data from the rest of the EU during clinical trials to increase the participant numbers and make the research more reliable, however it is not clear if this will continue after Brexit.
  • Possible migration of elderly UK-nationals who currently live in the EU back into the UK. The Northern Lincolnshire and Goole Trust have estimated that there could be 190,000 elderly Britons who migrate back to the UK after Brexit. This would cost the NHS an additional £1 billion every year and require 900 more hospital beds.

Junior Doctor Contract

This is an issue which was very prominent in the news a couple of years ago, but it is still relevant and you may be asked about it at interview so it is worth taking the time to understand what happened. The contract was imposed in October 2016 after a long period of disputes between doctors, the BMA and the Government. The disputes were predominantly about patient safety and working hours, although many other issues were also involved. In your future career, the Junior Doctor Contract will apply to you from the moment you graduate until you become a Consultant or GP, so make sure you know what it’s all about by reading over the news articles.

Mental health crisis

The department within the NHS with the greatest demand is mental health. 1 in 4 adults and 1 in 10 children experience a mental health illness2. The mental health services are facing significant struggles with unparalleled understaffing, underfunding and lack of resources. Read up on the Five Year Forward View for Mental Health in preparation for your medical school interview.

Understaffing

The NHS is the most understaffed it has ever been. According to NHS Improvement, there were 107,743 vacancies within the NHS in June 20183. This included a shortage of 11,576 doctors and 41,722 nurses3. Understaffing is becoming more and more of a problem, and as a result the NHS is spending huge amounts of money on locum and agency staff to fill rota gaps. It costs the NHS more to pay for locum and agency staff than to pay permanent staff, so this is a less cost-effective way of staffing hospitals. This worsens the (already significant) NHS financial deficit. Understaffing also leads to a reduction in the quality of patient care.

Before your interview, think about why the NHS is understaffed so that you are ready to discuss this and have some suggestions about how you would improve the staffing levels. Think about reasons why the NHS is struggling to recruit new staff, and why existing staff may be leaving. How would you tackle this if you were the Health Secretary?

Dr Bawa-Garba

This story was in the news in early 2018 but was not resolved until August. A six-year old boy named Jack Adcock died 11 hours after he was admitted to Leicester Royal Infirmary in 2011. Dr Hadiza Bawa-Garba was accused of neglect leading to Jack’s death. She was convicted of manslaughter by gross negligence and sentenced to two years in prison. She was struck off of the GMC Register in January 2018. Serious errors were made in this case, however it is widely felt in the medical community that Dr Bawa-Garba was not solely to blame for this and should not have been struck off the GMC Register. There were many other contributing factors which suggest that there were also failures within the system. Dr Bawa-Garba referred to the following in her defence:

  • She had recently returned to work after maternity leave and had not received any formal induction at her new hospital
  • The morning handover had not happened due to a cardiac arrest call
  • She had worked a 12-hour shift with no breaks
  • There was miscommunication on the ward
  • The ward was understaffed
  • She was the sole doctor covering the paediatric emergency department and the Children’s Assessment Unit (CAU) due to rota gaps
  • The consultant on-call was off-site until 4:30pm because he had not realised that he was on-call that day
  • At 4:30pm, she discussed Jack’s abnormal blood results with the consultant, who wrote them down in his notebook but did not take any further action
  • There was an IT failure which prevented blood test results being available as quickly as normal

Dr Bawa-Garba won her appeal in August 2018 and has now been reinstated back on to the GMC Register.

Charlie Gard

Charlie Gard was an infant who was born with mitochondrial DNA depletion syndrome, which causes progressive brain damage and usually leads to death in early life. From October 2016 when this genetic condition was diagnosed, Charlie received experimental treatment at Great Ormond Street Hospital under the NHS, guided by a specialist from the USA. However in January 2017, Charlie suffered seizures which caused brain damage and the staff at Great Ormond Street Hospital felt that continuing to pursue experimental treatment was not in Charlie’s best interests. However, his parents still wished to continue with the experimental treatment. In February 2017, GOSH requested the High Court over-rule Charlie’s parents. The High Court agreed with the position held by GOSH. Charlie’s parents then appealed to the Court of Appeal, the Supreme Court and the European Court of Human Rights. In July 2017, the specialist from the USA examined Charlie’s case and felt that his condition was too poor. It was agreed that he would be transferred to a hospice for palliative care and the life support machine was withdrawn.

Conclusion

The notes about each topic above are just brief summaries – it is important to do your own research and ensure that you understand each of these topics in sufficient detail to be able to discuss it at interview. Also make sure that you are keeping up to date with new NHS and healthcare-related issues as they happen so you can discuss the current issues that are relevant at the time of your interview. Like our page on Facebook to see all the latest medical news stories to help you keep up to date.

1 NHS staff from overseas: statistics.

NHS England. Mental Health.

3 NHS Improvement. Performance of the NHS provider sector for the quarter ended 30 June 2018.

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