The NHS

The NHS was launched in 1948. It was born out of a long-held concept that healthcare should be available to all, regardless of wealth – one of the NHS's core principles. With the exception of some charges, such as prescriptions, optical services and dental services, the NHS in England remains free at the point of use for all UK residents. This currently stands at more than 64.6 million people in the UK.

The NHS in England deals with over 1 million patients every 36 hours. It employs more than 1.5 million people, putting it in the top five of the world’s largest workforces, alongside the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army.

The NHS in England is the biggest part of the system by far, catering to a population of 54.3 million and employing around 1.2 million people. Of those, the clinically qualified staff include 150,273 doctors, 40,584 GPs, 314,966 nurses and health visitors, 18,862 ambulance staff, and 111,127 hospital and community health service (HCHS) medical and dental staff. The NHS in Scotland, Wales and Northern Ireland employs 161,415; 84,000 and 66,000 people respectively.

Funding for the NHS comes directly from taxation. Since the NHS transformation in 2013, the NHS payment system has become underpinned by legislation. The Health & Social Care Act 2012 moves responsibility for pricing from the Department of Health, to a shared responsibility for NHS England and NHS Improvement. The purpose of the 2012 act was to devolve decision-making from a centralised NHS to local communities, with the intent of making it more tailored to specific needs. The act aimed to put patients at the centre of the NHS, change the emphasis of measurement to clinical outcomes, and empower healthcare professionals, in particular GPs.


When the NHS was launched in 1948, it had a budget of £437 million (roughly £15 billion today).For 2015/16, the overall NHS budget was around £116.4 billion, with NHS England  managing £101.3 billion of this.

CRISPR-Cas9

CRISPR-Cas9 is a genome editing tool that is revolutionary in the scientific world. It is faster, cheaper and more accurate than previous techniques of editing DNA and has a wide range of potential applications.

It is a unique technology that enables genetic scientists to edit parts of the genome by removing, adding or altering sections of the DNA base sequence. CRISPR is currently the simplest and most precise method of genetic manipulation in the scientific community.

The CRISPR-Cas9 system consists of two key molecules that are able to alter DNA. These are:

•  an enzyme called Cas9- which acts as a pair of ‘molecular scissors’ that can cut the two strands of DNA at a specific location in the genome so that DNA can be added or removed (the generic type of molecule is called a restriction enzyme).
•  a piece of RNA called guide RNA (gRNA), which consists of a small piece of pre-designed RNA sequence (about 20 bases long) located within a longer RNA scaffold. The scaffold binds to DNA and the pre-designed sequence ‘guides’ Cas9 to the right part of the genome, ensuring the right DNA sequence is changed.

The guide RNA is designed to find and bind to a specific sequence in the DNA. The guide RNA has RNA bases that are complementary to those of the target DNA sequence. This means that, in theory, the guide RNA will only bind to the target sequence and no other regions of the genome, meaning that only the preferred section of DNA is altered.
The Cas9 follows the guide RNA to the relevant location in the sequence and cuts across both strands of the DNA. At this stage the cell recognises that the DNA is damaged and tries to repair it. It can theoretically change both alleles of a gene.

Forensic psychiatry

Psychiatry is defined as the study and treatment of mental illness, emotional disturbance, and abnormal behaviour. Psychiatry is a medical specialty, and so psychiatrists need to be medically trained to perform this type of medicine. This is the main difference between psychiatry and psychology; which can be defined as the study of behaviour and the mind, and can be thought of more as a social science. Forensic psychiatry is a specialised branch of psychiatry which deals with the assessment and treatment of mentally ill offenders in prisons, secure hospitals and the community. It is a particular aspect of psychiatry which I find interesting as it has extreme consequences in terms of the threat posed to society.

Forensic psychiatrists provide psychiatric treatment in a secure environment or where patients are subject to legal restrictions- meaning that the doctor needs an in-depth understanding of criminal, civil and case law as it relates to patient care in these settings. Treatment areas can vary from high security rural prisons to community centres. Referrals can range from those who have committed minor offences to serious and violent offenders, and for this reason the day of a forensic psychiatrist is never the monotonous. Forensic psychiatrists may also assess non-offenders displaying high-risk behaviour. Forensic psychiatrists also provide specialist advice to courts, probation services, and the prison service. They also prepare reports for mental health review tribunals, hospital managers’ hearings, other practitioners and criminal justice agencies.

Expert opinions given to court:

• ·         defendant’s fitness to plead and fitness to stand trial
• ·         capacity to form an intent
• ·         advice to the courts on the available psychiatric defences
• ·         appropriateness of a mental health disposal at the time of sentencing
• ·         nature of a particular mental disorder and link to future risks
• ·         prognosis and availability of “appropriate treatment”
• ·         level of security required to treat a patient and manage risk