Interview Questions: NHS Hot Topics

Tamsin Dyer

Tamsin Dyer

Senior Writer at Medic Mind

When we say NHS Hot Topics, what springs to mind? You may think of the big things you have heard about in the news recently, such as Brexit or the Junior Doctors’ Contract, but these aren’t the only current “hot topics” when it comes to the NHS. Below is a list of just some of the hot topics we think you should be aware of before your medical school interview:

  • Junior Doctors’ Contract
  • Brexit
  • A&E waiting times
  • Obesity Crisis + Sugar Tax
  • Mental Health Provisions
  • 7 Day NHS
  • Legal Cases – Dr Bawa-Garba and Charlie Gard Cases

Question: What can you tell me about the Charlie Gard case?

Answer: 

The Charlie Gard case was a legal case of best interest, involving the paediatric patient Charlie Gard, who had a rare mitochondrial DNA depletion syndrome, meaning he had progressive brain damage and muscle failure. 

The main issue surrounding the case was the differing opinions of Charlie’s parents and the doctors at Great Ormond Street Hospital, where he was being treated. Charlie Gard’s parents wanted Charlie to be treated with a trial of a nucleoside therapy, a therapy originally supported by the doctors in charge of Charlie’s care. This therapy was an untested and unlicensed drug, therefore requiring special approval. However, following a deterioration in Charlie’s condition before the treatment could be approved and administered, the medical team decided that the treatment was no longer an option, and would be “futile and would only prolong Charlie’s suffering”. Charlie’s parents were determined that he was to receive the treatment originally offered, and fundraised thousands to transport him to the US, where a specialist had offered to provide the treatment. The disagreement in treatment options reached a pinnacle when the team in charge of Charlie’s care at Great Ormond Street decided it was best to withdraw life support, which Charlie’s parents didn’t agree with. It was at this point that Charlie Gard’s parents appeared before the High Court to challenge the decision by Great Ormond Street to turn off Charlie’s life support. 

The differing of opinion for treating Charlie is why this case went to trial. The courts even prevented Charlie’s parents from taking him out of the country to the US to receive the treatment. In the final stages of the court hearing, Charlie’s parents accepted the view of experts in that medical treatment could no longer help Charlie, and it was time to withdraw life support. 

The Charlie Gard case, and others like it are very important to consider when thinking about a career in medicine, as being a doctor means you will come face to face with ethical dilemmas, such as this. Decisions about discontinuing life support is something that is difficult for doctors as there are so many things to consider. It is not just about the medical treatments and outcomes for the patient, but also to do with the patient, and their parents when looking at cases involving minors, their religion, beliefs, morals, feelings and thoughts. These are aspects of a patient’s life that should be considered when treating any patient, not just in extreme cases such as the Charlie Gard case. 

Key points to include:

  • Condition that Charlie Gard had – mitochondrial DNA depletion syndrome
  • Reason as to why this case was an ethical dilemma – Healthcare team wanting to take Charlie off life support, parents did not agree (child case)
  • Key points of the case – Treatment agreed, then Charlie’s condition worsened, treatment no longer viable. However, treatment offered by specialist in the US
  • Why is this case important? – what has it shown us about ethical dilemmas we may face as future doctors?

Extra reading on the Charlie Gard case:

BBC article – Charlie Gard: A case that changed everything? – link here

Ethic, conflict and medical treatment for children article – Chapter 1 The Charlie Gard case – link here

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Question: Name one consequence you think Brexit will have on the NHS?

Answer:

The United Kingdom’s decision to leave the European Union, or Brexit as it is commonly known, is thought to have many consequences on our National Health Service, despite the additional funding that the NHS may receive. Currently brexit is set to take place on the 31st January 2020, but this is all subject to change with the upcoming general election in December (2019). One of the possible consequences of Brexit on the NHS is staffing issues

The NHS currently already has a staff shortage of around 100,000 staff members across all sectors including, nurses, doctors, allied health professionals and care staff. Currently, one of the main ways of trying to combat this deficit is through international recruitment. Unfortunately, Brexit poses to impact on the ability for the NHS to successfully fill these vacancies. On top of this, 1 in 20 current NHS employees are from the EU, where they may choose to return following brexit, or if they are not granted EU settled status they may not have a choice in having to leave the UK. 

Like any of the possible consequences of Brexit on the NHS, staffing shortages are thought to happen, however, until Brexit occurs we can’t say for sure what the effect on healthcare will be. It is a time of uncertainty for the NHS, when it is already struggling, but with constant amendments to the withdrawal agreement bill, these current concerns may not be anymore. 

Additional thoughts:

This question has asked for a possible consequence of Brexit, meaning you could choose a positive or negative consequence to discuss in your answer. Other consequences you could have chosen to discuss:

Brexit benefits to the NHS
More money – There is the potential to have more money in the NHS budget, partly paid for by the Brexit “dividend” as Theresa May stated when she was prime minister. 
Brexit negatives on the NHS
Increased healthcare costs – UK could lose access to the reciprocal healthcare between the UK and the EU increasing costs.
Less staff – Currently 1 in 20 NHS staff members are from the EU

Extra reading on the possible effects of Brexit on the NHS:

BBC – Six key questions Brexit poses for the NHS – link here

The King’s Fund – Brexit: the implications for health and social care – link here

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Question: What do you know about the Junior Doctors contract dispute?

Answer:

The Junior Doctors contract dispute started back in 2012 when Ministers drew up plans to change the junior doctor contract, however it wasn’t until a few years later that talks between the government and the BMA (British Medical Association) broke down. Ultimately leading to the major conflict in 2016, with the Department of Health re-writing the employment contracts for all new doctors starting in England from August 2016. The new contract applied to all doctors below consultant level. The new proposed contract would affect how much junior doctors got paid, as well as affecting their decisions around which specialty to pick, and even decisions to interrupt their career to have children or undertake further academic qualifications. 

Definition:

Junior Doctor – Refers to any doctor below consultant level. It is a term that is quite misleading as many assume that it refers solely to newly qualified doctors. 

Original Dispute:

When thinking about the Junior Doctors dispute it is important to consider both the views of the government and the doctors. 

Governments View
Recommendations based on the following criteria:Improve patient care Maintaining respect and trust for consultants and junior doctors as leaders and professionals Credibility and practicality of local implementation Appropriate remuneration (in order to recruit, retain and motivate)To help facilitate constructive, continuing relationships Affordability
The new pay systems “looks to improve patient outcomes across the week, through providing separate unsocial hours payments” 
New pay system said to increase basic pay from the previous £22k.
The Department of Health was quoted saying “these proposals, endorsed by the independent pay review body set out a fairer deal for all medical and dental trainees so that their pay relates to actual hours worked.” 
Doctors View
Previous pay: standard rate of pay for shifts where the hours fall between 7am – 7pm on Monday to Friday.Allowing supplement for hours worked in “unsociable hours” called banding. Which junior doctors boost their basic pay by 40-50% with the use of banding. Previous basic pay £22k
Proposed pay:Standard rate of pay for shifts where the hours fall between 7am – 10pm on Monday to Saturday = an additional 30hours per week at standard pay, despite it being “unsociable hours”This would ultimately result in a pay cut for doctors

Strike action:

12th January 2016 – first general strike across the NHS, first such industrial action in 40 years. Emergency care was still provided

10th February 2016 – 2nd strike or routine care, but continue to provide emergency care

26th April 2016 – first strike where junior doctors withdrew both routine and emergency cover

It is important to note that there was no significant effect on the number of recorded deaths during the strike periods. However, nearly 300,000 outpatient appointments were cancelled.

Agreed new contract deal for Junior Doctors in England – 2019 Improvements:

  1. £10 million investment in rest areas – BMA fatigue and facilities charter inspires investment in English hospitals
  2. Pledge to improve record-sharing – NHS commits to end the administrative burden for juniors starting new rotations
  3. Enhanced shared parental leave 
  4. Whistleblowing protection – new legally binding protections secured for junior doctors raising concerns at work
  5. Supporting LTFT locum work – confirmation that LTFT trainees would face no regulatory barriers to pursuing locum work. 

Extra reading:

BBC article – Junior doctors’ row: The dispute explained – click here

BMJ articles – Agreed new contract deal for junior doctors – 2019 – click here

Question: What are potential consequences of the sugar tax?

Answer:

The sugar tax, officially known as the Soft Drinks Industry Levy, was introduced in the UK in 2018 to address the current obesity crisis. In the UK almost a third of children and 60% of adults are overweight and obesity costs the NHS £5.1 billion per year. It has been supported by the British Medical Journal that an estimated 20% tax on sugar-sweetened beverages would reduce obesity by approximately 1.3%. There are both pros and cons to consider regarding the use of the sugar tax.

Benefits of Sugar TaxConsequences of Sugar Tax
Increased revenue that can be spent on other areas that require funding in the NHSNegatively impact those with lower socioeconomic status
Reduced spending on treatments for conditions associated with obesity e.g Type 2 DiabetesMay not lead to a reduction in obesity as there are multiple contributing factors
Reduction in the level of tooth decayStrips people of their autonomy by pricing sugary drinks above what they can afford
Benefits and Consequences of Sugar Tax

Extra Reading:

BBC article – Soft drink sugar tax starts, but will it work? – link here

BMJ article – Consumption of sugar from soft drinks falls – link here

Question: What do you know about the mental health crisis?

Answer:

1 in 4 adults and 1 in 10 children experience a mental health illness in any year. The rate of suicide is rising, particularly in young men with men being three times more likely to take their own life. Mental health services are struggling due to understaffing, lack of funding and resources.

To tackle the mental health crisis the government pledged £1.25 billion for a new national mental health programme before 2020/21. The Chancellor also highlighted an additional investment of £250 million in new crisis services including 24/7 support via NHS 111 and more mental health specialist ambulances. There were also aims to prioritise services for children and young people such as mental health support teams based in schools and specialist crisis teams for young people.

This is an important issue as within any field in medicine you will deal with patients that have mental health issues so you need to be well-educated to be able to identify these patients and the services you can direct them to. You could potentially be asked how you would tackle the current mental health crisis, try to mention increasing investment and staff numbers as well as educating doctors and nurses in all specialties.

Extra Reading

BMJ article – Adolescent mental health in crisis – link here

BMJ article – Mental health in the UK during COVID-19 pandemic – link here

Question: What can you tell me about A&E waiting times?

Answer:

Measuring A&E waiting times is a tool used to assess how a well a hospital is performing. This is helpful information because it shows if there is enough staff for the service and monitors patient safety by seeing how quickly patients are seen. The specific target set is that 95% of patients should be seen within 4 hours of their arrival into A&E, this was originally set at 98% when it was set in 2004 but was relaxed in 2010. The percentage of A&E patients being seen within this 4 hour window has been falling over the past years. The number of patients waiting over 4 hours has grown by 557% over the last 7 years.

There are differing views regarding whether the 4 hour wait time should be scrapped so it’s good to familiarise yourself with these points so you can form your own opinion. The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, opposes the four hour target as well as additional targets that are currently being considered. These extra targets include ensuring most urgent cases are seen within an hour. The RCEM has warned that asking some patients to seek care elsewhere e.g a walk-in centre or wait a lot longer than present would not deter patients with minor injuries and illnesses from arriving. Instead, it could lead to more aggression and violence by frustrated patients.

It’s worth noting that patients do like the target and feel that it ensures staff are focused on seeing them faster. If the target was removed, there are concerns that people with non-life threatening conditions having to wait excessive amounts of time. Another consideration is having different targets for different levels of conditions as the target currently applies to everyone who turns up to A&E.

Extra Reading

BMJ article – Overcrowding and long delays in A&E caused over 4000 deaths – link here

BBC – A&E waits worsen – link here

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