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

Trichromatic vision in Humans

The human eye is the visual pathway to the world around us, and enables most of us to see thousands upon thousands of different colours. As shown in figure 1, the human eye is a very complex organ, with many different structures help us get the best vision in different situations- dim or bright etc. - and when all of these parts perform in harmony, we are able to see clearly.

In order to understand how we see different colours, it is first imperative to understand how the eye works as a unit: the starting point of vision is when light rays reflect off an object and enter the eyes through the cornea-the outermost, transparent layer of the eye. The rays are then refracted by the cornea and pass through the pupil- a whole created by the iris to control the amount of light passing through it. After that the rays pass through the lens- which can bulge or shrink to further refract the rays in order to focus them on the retina at the back of the eye.

The retina is an extremely thin layer of cells at the back of the eye which contains millions of light-sensitive cells called rods and cones- and are also known as photoreceptors. Cones are concentrated in the center of the retina (the macula) and in bright light conditions, they provide precise vision and detect colours. Rods however, are located outside the macula and extend all the way to the outer edge of the retina. They provide peripheral vision and allow the eyes to detect motion and help us see in dim light and at night. These photoreceptors then convert the light into electrical impulses which are sent to the brain via the optic nerve at the back of the eye, and create an image in our head.

As previously mentioned, we are able to see colours due to cone photoreceptors, of which there are 6-7 million of in the retina of each eye. Most of them are located in a 0.3mm spot on the retina called the fovea centralis, and over the last few centuries experiments have given evidence that amoung these cones there are three different types of colour reception: red (64%), blue (2%) and green (34%). This was proved by two different groups of scientists: Wald and Brown at Harvard, and Marks, Dobelle and MacNichol at Hopkins in 1959. However, the first original theory of there being three different light sensitive ‘particles’ was put forward by Thomas Young in 1802, 136 years after Sir Isaac Newton’s famous discovery that white light contained thousands of different colours (due to their different wavelengths on the electromagnetic spectrum), and so enabled us to understand where colour ‘comes from’.

"Colour is the visual effect that is caused by the spectral composition of the light emitted, transmitted, or reflected by objects” and when a light ray of a certain wavelength hits the fovea centralis, it activates the three different types of cone to varying degrees, and with an infinite amount of varying combinations, we are able to see thousands of different colours. This is shown in a simplified diagram in figure 3, but in reality this diagram would be a lot more complex because of the ranging number of shades which belong to each colour. To prove that any colour visible to humans can be created from this trichromatic system, we can use the example of TV sets; if you look at a normal television up close when it is switched on, the tiny pixels contain just 3 colours: red, blue and green (as shown in figure 4).

The human eye can perceive many more variations in warmer colours than cooler ones due to the fact that almost 2/3 of the cones process longer light wavelengths and so we are able to see more yellows, oranges and reds. Additionally, the reason we can’t see colours in the dark is because the rods ‘take over’ to control the amount of light that we see, and so the cones aren’t in control anymore. Furthermore, about 8% of men and 1% of women have some type of colour impairment; the most common of which is red and green dichromatism, which causes the colours red and green to appear indistinguishable.

In conclusion the reason why humans can see thousands upon thousands of different colours is that, despite only having 3 types of cone photoreceptor, the cones send-off varying amounts of blue, red and green to the optic nerve to be carried to the brain, and by changing these amounts of light, all of the colours in the visible spectrum can be produced.

The wonders of ECMO

The extra-corporal membrane oxygenation machine is one of the wonders of 20th and 21st century medicine, as it acts as an artificial lung outside of the body, oxygenating the blood and pumping it round.

ECMO was first used successfully in the USA in 1976 and was introduced in the UK in 1989. It was first set up in a paediatric setting at Great Ormond Street Hospital in 1992 and to date they have supported over 850 babies and children. This is of vital significance as ECMO machines are mostly used on children and babies, but are sometimes used in adults with cardiac and respiratory failure.

There are two main types of ECMO: veno-arterial and veno-venous. In both types, blood drained from the venous system is oxygenated outside of the body. In VA ECMO, this blood is returned to the arterial system and in VV ECMO the blood is returned to the venous system- in this typr of ECMO there is no cardiac support.

In veno-arterial ECMO, a venous cannula is placed in the right common femoral vein for extraction and an arterial cannula is placed into the right femoral artery for infusion. The tip of the femoral venous cannula should be kept near the junction of the inferior vena cava and right atrium, while the tip of the femoral arterial cannula should be kept in the iliac artery. Central VA ECMO may be used if cardiopulmonary bypass has already been established (with cannulae in the right atrium and ascending aorta).

In veno-venous ECMO cannulae are usually placed in the right common femoral vein for drainage and right internal jugular vein for infusion. Alternatively, a dual-lumen catheter is inserted into the right internal jugular vein, draining blood from the superior and inferior vena cava and returning it to the right atrium

ECMO can be used in the operating theatre straight after surgery or on one of the intensive care units. If a patient is going through ECMO after cardiac surgery, the surgeon will usually insert the cannulae (tubes) during the operation, directly into the heart through the chest. Whereas, if ECMO is started in the intensive care unit, the cannulae connecting the patient to the ECMO circuit are placed directly into the blood vessels on the side of the neck.

Once in place, the cannulae are then connected to the ECMO circuit. Dark deoxygenated blood drains from the patient through the tube in the vein and is pumped through the membrane oxygenator where carbon dioxide is removed and oxygen added. The blood is then re-warmed and returned to the body. This process goes on continuously while the patient is on ECMO. Additionally, they will also stay on a ventilator but on very gentle settings which allow the lungs to rest.