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.

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

The Junior Doctor Strike: What You Need To Know

In the last few months junior doctors all over the UK have been heavily objecting the proposed changes to the junior doctor contract proposed by the government, which has led to a 24-hour strike of over 90% of the UK's junior doctors, leaving the NHS in a state of distress.

This opposition has arisen as the government has decided that the current contracts are ‘unfair’ and too old-fashioned, and even though the initial plans for a new contract were first drawn up in 2012, talks only started breaking down in 2014. The government has indicated it will impose the new contract in England and the British Medical Association (BMA) has responded by initiating the industrial action process.

So, what exactly is a ‘junior doctor’? The term ‘junior doctor’ refers to doctors which have just graduated from medical school up to doctors which have had up to 10 years’ worth of experience being a fully qualified doctor- to most people a 32-year old hospital specialist would seem to be a ‘senior’ and well-qualified doctor. The starting salary for a junior doctor is currently just under £23,000 a year, but with additional payments for extra services such as unsociable hours, this can quite easily top £30,000.

Junior doctors at the top end of the spectrum can earn just over £70,000 per year. However, it's important to remember these doctors often make life-and-death decisions and carry out surgery, in addition to having over 10 years’ worth of professional experience as a qualified doctor.

Given that 1/3 of all doctors in England are junior doctors, this contract change will directly affect around 55,000 doctors, making it a lot harder so earn more money and work healthy hours.

The proposed changes to the contract will change the standard working hours for junior doctors in England, which are currently set at 0700-1900 Monday-Friday, which is already quite long and is certainly a strain on the NHS. What the new contract proposes is that these standard hours would change to 0700-2200 Monday-Friday in addition to 0700-1900 on a Saturday- which is, in my opinion, quite ridiculous as this implies that working on 0800 on a Monday morning is the same as working on a 1900 on a Saturday evening.  As the standard number of hours has increased, it means that junior doctors will have to work practically all week to earn a decent pay for the first few years or their careers.

Another problem which will almost certainly arise is extreme tiredness and fatigue, which is already a problem within much of the NHS and will be made even more common with these new changes. With this proposed change, therefore, comes the question of patient safety, as it has been proven that doctors make more mistakes practicing medicine whilst being tired than drunk, which ultimately poses the question: to what extent would you be comfortable with an exhausted surgeon operating you who is more likely to make a mistake than a surgeon under the influence of alcohol?

The main problem the government is trying to solve here is timings: in an ideal world, they would like to see a 24/7 NHS which everyone has complete access to; however, they are trying to do this without spending huge amounts of money by employing more doctors, and so, there is only one foreseeable solution without spending huge amounts of money- to stretch the capacity of NHS doctors.

Personally, as a prospective medical student I think that this change in contract has very few proper advantages, as, even if we have a fully running 24/7 NHS, what is the point if barely any of the doctors are working to their full potential and putting the lives of thousands of patients at risk every day?

Should we ban smoking?

Smoking tobacco is the most expensive social burden in the UK, costing the government roughly £65 billion per year. It also indirectly accounts for up to 20% of deaths in the UK, as it is the main causing factor of lung cancer and smoker's illnesses, such as chronic bronchitis and emphysema. Despite 65% of regular smokers dying from some form of respiratory disease, 20% of the English adult population still smoke; causing huge strains on both a personal and national scale, which raises the question: should we ban smoking?

The reasons for the ban of smoking are pretty simple if you think about it: increased life expectancy, quality of life and a less-stressed NHS. On average, the life expectancy of a smoker is roughly 5-10 years lower than a non-smoker, and in addition to this the DALYs (disability-adjusted life years) of smokers can add up to around 15 years- about 1/5 the average life. Furthermore, 1/3 of cigarettes in Britain are smoked by people with mental illnesses, seriously worsening their physical health, in addition to their mental issues. 

COPDs (Chronic obstructive pulmonary diseases) are found in around 58% of smokers, and this includes diseases such as chronic bronchitis, emphysema and lung cancer; the former two of which cause permanent and irreversible lung damage. Emphysema is a condition in which the phagocytes in the blood move to the inflamed lung tissue when smoking and release the enzyme elastase (in order to reduce swelling), which then digests the walls of alveoli- therefore reducing their surface area, meaning that gas exchange happens less efficiently and so people who have this often have to have a constant flow of oxygen going into their blood stream (often an oxygen tube) so that their body has enough oxygen to function. 

In addition to this, countries where tobacco is farmed are extremely poor, and often the average worker on tobacco farms is a child. This is the case in Malawi, where almost all of the workers have gained a nicotine addiction from handling the tobacco leaves every day, but they are often forced to carry on as, for many, this is their only source of income (this often results in nicotine poisoning). Furthermore, there are also many environmental impacts which tobacco farming has, including deforestation, of which 26% is due to tobacco farming in Malawi. 

In conclusion, there are simply no advantages of smoking tobacco - apart from the social factor of thinking its 'cool'-, so why not just ban it? Well, its not as simple as that.

Many people argue that every human being has the right to do what they want with their own body- which I partially agree with, as I think that one's body is truly one's own; however, I think that if one is harming themselves or the people around them this belief is partially compromised. This belief is applicable to not only smoking but a huge range of other medical issues and diseases, such as obesity, substance abuse and alcoholism, and, such as with many other ethical issues surrounding medicine, there is no prefect solution to this problem.

As with any other damaging burden, the government and the NHS are trying to persuade people to stop and try to live a healthy lifestyle, however I don't think that there will ever be a complete ban on smoking due to the belief that everyone can do what they want with their body; but, I do think that this raises questions such as: why is prostitution illegal if everyone can do what they want with their own body?

In a nutshell, theoretically a ban on smoking would do more good than bad, as it would improve millions of lives across the UK, but due to ethical issues it is simply not feasible in the real world that we live in.