The NHS provides care free at the point of us to British citizens and anyone who needs emergency care while in the UK. It tries to provide every kind of service and treatment that it can but obviously there are limits.
The NHS gets its money mainly from governments taxes, charities, research grants, some payment for services and from renting out retail space etc. Healthcare is a financial blackhole, any money put in the budget will get spent, efficiently and effectively or not.
The NHS is constantly being expected to provide a better, more efficient service and new treatments, without a comparable increase in government funding. So, why doesn’t the NHS set up services that could make it money?
Some money making suggestions
Gift shops and NHS clothing brand – The American hospital I went to for elective had quite a large shop near the entrance that sold hospital branded goods. People love the NHS and it could make itself a brand, “I love the NHS” t-shirts, “I was born here” ties, “I gave birth at Blah hospital” car stickers, hats, jackets, tracksuits, teddy bears in white coats and so many more things could be sold in this shops to raise money for the NHS.
Patients in a hospital are a captive market and their visitors are semi-captive. The captives get very bored! Why not provide opportunities for these people to spend their money and relieve the boredom while they are in hospital with some retail therapy? For instance, new hospitals should be built with a shopping mall in them and a cinema. A couple of clothes shops would give people something to do and raise money from rent.
While we are on the subject of new hospitals, they should be designed with the input of the clinical staff who know how to maximise the flow of patients through the "patient pathway". Hospitals should be built like industrial conveyor belts: patients enter through ED, get stabilised, get fixed in theatre, stabilised again in ITU, recover on the wards and out the exit to social services and the outpatient clinics.
New hospitals should be designed to sit on top of HUGE underground multi-story car parks. If shopping centres can do this then so can hospitals. Almost all hospitals are short of parking spaces and most car parks are eye sores. So, try to plan from the beginning to get as many car parking spaces as possible. Estimate how many are needed for staff and visitors - then double it! Also, design a park and ride system so additional parking is available off site.
If costa can make money from a coffee shop in an NHS hospital, why isn’t the NHS setting up its own brand of high quality coffee shops in the hospitals and cutting out Costa the middle man?
“NHS healthy eating” – NHS branded diet plans or ready meals could be produced in partnership with a supermarket brand. Mixing public heath, profit and the NHS brand. “Good for you and good for the NHS”
The NHS could set up hospitals abroad that are for profit institutions that use the NHS structures, or market our services to foreigners that they then pay for. Health tourism is a thing, why not make the most of it?
“NHS plus” – the NHS should be a two tier system. Hours of 8am til 6pm should be for elective procedures free at the point of use and free emergency care. Between 6pm and 11pm the hospitals currently only do emergency care, so there is loads of rooms and kit lying about unused. Why not allow hospitals to set up systems where patients can pay for an evening slot in the MRI scanner and cut the queue? Allow surgeons to pay to use the facilities for private procedures in the evenings. Allow physicians to pay to use the outpatients clinics for private work after hours.
An “NHS Journal” could publish research and audits conducted within and relevant to the NHS.
“NHS pharma” – the NHS buys a huge amount of off patent drugs, why not produce them itself? Set up a drug company that produces off patent medication, these can be given to the NHS at cost price and sold to other healthcare providers for profit. NHS pharma could also work with British universities and researchers to produce new drugs for the British market that would be cheaper than new Drug company drugs because they wouldn’t need huge advertising budgets.
There are so many ways the NHS could make more money for itself that could then be used to deliver newer and better treatments. Yes, it is a shift in ideology and culture, but I am sure it would have positive outcomes for the NHS and patients.
If you have any ideas on how the NHS could produce more money then please do leave a comment.
Thousands of doctors are currently preparing portfolios and stressing about situational judgements as they go into core and specialty training interviews. As a medical student I wasn’t even aware when these interviews were and had only the briefest imaginings of what they might entail. Even at finals, specialty applications felt a million miles away; but it’s as if you’ve only just got through the misery of MTAS and you’re suddenly an F2 realising that the last 15 months have, to your surprise, disappeared.
Yes, the interview is certainly a stressful situation, and for many medics it’s only the second ‘proper’ interview they’ve ever had. Time pressures, the scope of stations and performing under the watchful eye of the great and good of the medical profession only add to the stress. But, there are ways to make this process bearable, and, dare I say it, enjoyable (kind of).
The most important step is preparation. Not just the preparation that starts in the days to weeks before the interview; this should be for refining your skills, getting your answers super-slick and getting to know yourself inside-out. Preparation starts at university (and no, which school you’re in doesn’t make a single difference). What the interviewers are looking for can be found in the person specification unique to each specialty (found at http://bit.ly/1eWF6aN). I.e. if you know you were born to perform heart surgery, start looking at what the interviewers for cardiothoracics are looking for. Even if you’re completely confused about your career path, it’s time to start thinking.
Many specialties still have a short-listing stage dependent on the application form. Whether assessed on the form or at interview each specialty will (generally) award points for other/higher degrees, publications, presentations, prizes, teaching experience, audit and ‘commitment to specialty’. At the CT1/ST1 stage it doesn’t matter what subject area you published/presented/taught in etc. to score in that section; but having something relevant will help you discuss your commitment to that specialty. ‘Relevant’ in itself is misleading however; every experience is likely to be relevant when you identify the transferable skills involved and what you learned from the experience. Some specialties are stricter and you’ll need demonstrable evidence that you haven’t just applied on a whim. These tend to be the more competitive specialties which demand evidence you’ve had a really good look at what the job involves and have taken steps to broaden your knowledge.
There is typically also at least one skills station which may be general (e.g. breaking bad news to a patient) or specialty-specific (e.g. interpreting images for radiology) but are still based on applicants demonstrating they fit the person specification. Many of the mark schemes are also freely available on the relevant Royal College website, and I encourage you to have a look and see where you could get a few more points (or give yourself a pat on the back that you couldn’t). It’s unlikely that the mark scheme/person spec. will be exactly the same every year, but the general overview is enduring.
NB. The GP application is a bit different, but that’s for another post.
The take home message is get involved early on, and be involved consistently. It may eat up some of your free time but you’ll appreciate it as soon as you look at the application form. If you’re struggling for practical ideas, take a look at the Royal College and specialty trainee websites for inspiration (some, for example the Royal College of Radiologists, have great audit ideas). The RSM and each medical school have a list of available prize essays and exams. A wise person once said to me “there’s no such thing as a wasted conversation”: Speaking to trainees and consultants about how they got to where they are not only gives you great insight into what they do but being friendly and enthusiastic can open up doors for you to help in audits and publications. And the final tip? Write everything down. Not only will this stand you in good stead as a safe doctor, but you’ll be surprised how much you can forget in a very short time. Then, unlike me, you won’t have to spend ages trying to think of reasonable examples of ‘when I dealt with stress’.
Written by Lydia Spurr, FY3 Doctor
Lydia is a Resident Meducation Blogger
I was approached by Meducation to become a resident blogger, and was initially surprised by the invitation as - I must explain upfront - I am not a clinician of any type! I'm one of those project managers. So when considering where to begin to write my first blog post I decided to focus on the use of technology in medical education.
Then when I began writing my first post I was reminded of the complexities of such a topic! And I realised that this is not something that can be covered in one post.
So this is where I thought I would start:
Technology is changing our lives at an ever increasing rate, and it is influencing the way we do a range of tasks from the use of technology in the hospital to the use of technology in education, notwithstanding all other aspects of our lives and the way we communicate. We are educating children in schools at the moment who will have careers and jobs that don't even exist at the moment, the rate of change is exponential. But with this consistent churn of information, communication and technological developments, how do you keep up? Where do you start? As a teacher, as a learner.
I wanted to concentrate this post on considering some of the challenges which can be encountered when working in medical education. One of the pivotal issues is probably resistance. Resistance has a negative connotation and I use it cautiously. Resistance can be in many forms and can arise for a number of reasons.
Technology brings about change, and inherently change can make people nervous. And with change you often encounter resistance; resistance to change, resistance to adapt, resistance to engage - the fear of the unknown. With an ever evolving world, where technology is infiltrating the way we live, work and learn, it is natural that this will influence the way we deliver education, including medical education.
Technology is so fast moving it can considerable time to become familiar with new mediums of developing educational resources, by which time often new iterations and new technologies have arrived.
However, for those providing subject matter expertise for educational resources it is essential that they under the medium through this will be delivered. And for learners, which we all are, it is important to understand how you learn and how technology can help you do this.
With the changes to the NHS and developments in education technology do people find some comfort in being able to both deliver and receive education in a traditional manner?
This poses a unique and very interesting challenge to answer for those involved in medical education, in trying to meet the demands of those seeking information and education in new and interesting ways with those who enjoy traditional classroom based education - all from both the point of view of the 'teacher' and the 'learner'.
How to we satisfy the appetite of those seeking cutting edge education with the demand for traditional classroom learning? Is it possible to meet the needs of all?
So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly).
And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from?
Science believes it may have discovered the answer- mirror neurons.
In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'.
It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons.
Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return.
Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.)
Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way?
Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared.
However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place.
Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing.
So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!