The RighT Medicine?The US Health Reform debate explained.

OctOber 2009

Sci-Fi SuRgeRyThe Future Is Now!

dying FoR A dRinkShould the 6-month transplant rule be waived?

A BRAND NEW YEAR A BRAND NEW LOOK

cASuAlTy cRunchThe impact of the recession on the NHS

An IndependAnt publIcAtIon by StudentS of unIverSIty college london MedIcAl School

The Bell

FRoM The deSk oF The ediToR

Jagdeep Singh Mohal

Welcome back to

another year at UCLMS. The year has got off to a fantastic

start already by UCL being ranked the 4th best university in the world. This is a truly amazing achievement! We are all so fortunate to be studying medicine at such a great institution so well done to everyone for making this possible.

We say farewell to Raj Badiani and Hitesh Tailor who have now left The Bell Magazine team owing to other commitments. I would like to give them my personal thanks for helping in the production of the last three issues.

We welcome Dominic Pimenta to the team who has already redesigned the entire magazine for the start of the New Year. We look forward to seeing how he with the rest of the team helps to further improve the magazine. In this issue you will find some very topical stories.

We are again thankful to our

Clinical President for shedding light on the various student proposals put to the medical school and union to enhance our experience of studying at UCLMS. We again highlight the vital work being carried out by MSF which is now an official UCLU society. The remarkable perseverance of MSF is highlighted in an article recounting their work in the conflict zone of the Dominican Republic of Congo. I urge you to participate and learn more at their events.

Like many of you I’ve been following the health care debate in the US very closely and this formed part of the reason to include an article about it in this issue. It’s a good read for anyone who wants to see an entertaining take on why it’s so difficult to get universal health care in the US and just might make you feel grateful for having the NHS. Speaking of which, what’s happening with that? Sundeep Patel explains all. All I can say is we’d better start following UK health policy as closely if we want to be sure about how decisions taken now affect us in a few years.

There are shortages of resources to contend with and this is brilliantly highlighted by the recent case of a patient who died

after not being offered a liver transplant because he couldn’t stay sober for 6 months. You’ll find the twist is in the tale. There is hope though as we find out about some remarkable futuristic proposals on how medicine could be turned on its head with the emergence of Sci Fi doctors.

Coming back to present day surgery however, we have the ever wise guiding hand of Surgical Society who have an exciting line up of talks for this year so do get involved with them too.

Best of luck for the coming year.

Jagdeep

www.thebellmagazine.co.uk

2

Sacha DhanjalDeputy Editor2nd Year Clinics

devesh shahDeputy Editor2nd Year Clinics

dominic pimentaDesign1st Year Clinics

ansuya puriWebsite&Design2nd Year Clinics

roselin charlesSecretary1st Year Clinics

The Bell TeAM

Charles Bell

1774-1842The BellINSIDE THE MAGAZINE

3 Welcome From the clinical PresidentMandy SMith

4 sci-Fi surgery a glimPse oF the Future doMinic PiMenta

6 usa a-oK? healthcare reForm exPlained toMMy taylor

8 dying For a drinK: 6-month rule? rebecca Sloan

9 msF raise thousands For congo aidKatherine Pitt

10 the imPact oF the recession on the nhsSundeeP Patel

Mandy SMith* uclu-clinical.president@ucl.ac.uk

HAIL TO THE CHIEF!

To all you veterans, welcome back to another year of GP

commutes, pathology and PDS and sore feet up on the wards. To all of you freshers, welcome to the 4th best university in the world in the best city in the world.

My name is Mandy Smith and I am the new Clinical President for 2009-2010. I aim to repre-sent you to the University, the Union, the UK Foundation Pro-gramme Office, the BMA and a number of other groups. This year looks set to bring dramatic changes, with an overhaul of areas from the foundation job application process to the intro-duction of new portfolios and curriculum reviews. We have in-filtrated the majority of medical school committees with student reps who receive training in how to collect feedback and contrib-ute to discussions so your feed-back is used effectively. Within the union RUMS exec looks set to have a full cohort including a range of new officer portfolios to encourage development of our welfare, education and events initiatives. For anyone that wants to get involved please just contact

me and I can point you in the right direction.A number of issues that will be dealt with include:

•Upcoming changes to the Foundation Programme Applications. You are represented on the United Kingdom Foundation Pro-gramme board by Keith

Aubin from the final year and myself from the 4th year. We’re here to answer any questions that you guys put to us. With the guarantee of drastic change we will work to ensure that you are fully informed and prepared to ensure you get the best shot at your first choice Foundation school, whatever the new system.

“This year we hope To sTrengThen The ‘r.U.M.s

Brand’inside and oUTside of The Union”

•The position of RUMS within the union. This year we hope to strengthen the ‘RUMS Brand’ in-side and outside of the union by building on our strongest points, like our sports teams, and de-veloping new areas, like profes-sional interest groups and cam-paigning. With increased student engagement and awareness of is-sues that affect us we will be able to defend our best interests and proactively improve provisions for the medical students. Recent successes include motions to the UCLU Welcome General Meeting to protect the sports teams from mergers and the naming of the

new union bar ‘The Huntley’.

•Education. This is an ongoing engagement with the medical school – student representa-tives sit on the module manage-ment groups for each rotation and provide constant feedback to facilitate changes and devel-opments that favour medical students and their clinical expo-sure and opportunities. The reps are trained and are eligible for a certificate for their contribution to the medical school at the end of the year. There were a huge number of strong applications this year and we have tried to involve as many as possible. We hope that the quality of feedback and therefore outcomes will continue to improve this year.

Finally, please please please keep your eyes on the RUMS bulletin – we are going to be asking for reg-ular feedback from you as well as feeding everything discussed back to you!. Any issues affecting you within the university, un-ion or more national issues will be posted for your information.So get involved, keep up to date and if you have any ques-tions just get in touch atthe above address.

Good Luck with your year and have fun!

amanda Smith

CliniCal preSident

3

4

You enter the doctors office. Smooth, shiny, sterile. A camera scans your face and

palms and registers your appointment, bidding you “welcome” on a screen. A plaster followed by Instructions is dispensed below the screen. You put on the plaster, take a seat and your vitals appear on a screen for your own perusal. Blood pressure. Heart Rate. Temperature. Your seat slides through a wall. You are now in the doctors “office”, where the doctor asks you some simple questions from a mobile television screen that moves around the office. He takes a blood sam-ple via the plaster and analyses the results on the screens. He decides you need treatment, and asks you to place your hand out. An auto-mated arm from a robonurse locates your palm and tenderly injects, painlessly without break-ing the skin. Hundreds of thousands of tiny nano robots flood into your bloodstream. They will assemble and begin therapy within your body immediately. When they are done they will shut down and pass through your kidneys and into your urine, and you’ll be right as rain.

Is this the future of medicine? Last year I wrote about the current use of robots in surgery to-day, but this world is expanding at an exponen-tial rate. Everything in medicine and surgery is getting smaller, smarter and more complex.

The Hunterian Museum at the Royal College of Surgeons recently opened a new exhibition entitled Sci-Fi Surgery: Medical Robots past, present, science fiction and science fact. The usual suspects in current use were present and accounted for; Probot, the first surgical robot which assisted in transurethral resection of the prostate, shared the antiquities cabinet with an earlier model of what is now the Da Vinci gener-ation of medical robots. The real buzz however,

was around the proto-types; the trailbreakers into the potential fu-ture of surgical robots.

Moving away from

robots that enhance the role of the surgeon, these prototypes go where no surgeon can. The ARES Prototype

Robot comes in 15 cap-sules each s w a l l o w e d individually. Once inside the gut lu-men they a s s e m b l e

themselves into a working internalized ro-bot capable of diagnosis or full-on surgery.

Although not at the exhibition, the future of the post-operative period is not without its own revolution. Robotic nurses such as “Pearl” and “RI-MAN” were shown in video demos ten-derly picking up and carrying patients then gently laying them down elsewhere. Whether these robots will develop a bedside manner to match their manhandling remains to be seen.

Surgery is not the only area science fiction

is becoming science fact. Also on show were Toumaz Technology’s “Digital Plaster”, a dis-crete patch stuck to a patient, capable of moni-toring respiratory rates, pulse, blood pressure and ECG, and transmitting that information wirelessly to a central hub, and then anywhere in the hospital. The clinical value of instant ob-servations is obvious, as well as the potential for instant response to patient emergencies.

Also cruising the exhibition was the RP-7 Remote Presence Robot (InTouch), a remote-controlled robot with a camera/screen com-bination mounted on top. This could enable a doctor to make his ward rounds, consult with staff and interview patients from anoth-er hospital, from home or even on holiday!

The future here described is as daunting as it is exciting. Will these even make it into clini-cal practise? Or could this be the first tentative steps into an increasingly automated, robotic and digital world of medical care? Lets hope there’s still a job to do for the human-doctor at the end of it. And not polishing the robots.

doMinic PiMenta

the ARES prototype robot

RI-MAN Robot

ViSit the exhibiton!More inforMation-www.rcSeng.co.uK

sci-fi surgery: the future is now

5

It is a question many medical students face dur-ing their years at medical school. Surgeons, es-

pecially those of the orthopaedic trade, are stereo-typically known to be barbaric & caveman-like. In reality, however, this clearly is not the case!

Surgery is becoming a more and more competitive field. Even before finishing medical school, aspir-ing surgeons are required to have had a reason-able foundation of experience and skills on their CV to increase their chances of future success. It is a big task for an individual, but fear not, for there is help along the way…

Now in its sixth year, UCL Medi-cal School’s (formerly RUMS’) very own Surgical Society has been growing larger and stronger each year. In conjunction with the Royal College of Surgeons of England, the society aims to make students aware of the career options in sur-gery and prepare you with the knowledge and skills to enter this ever-expanding field.

The regular highly-demanded Basic Life Sup-port and Suturing workshops are a good start to build up your mental and digital dexterity and aptitude. Plastering workshops and the annual external fixation workshops are also a treat for orthopaedic enthusiasts. With the increasing popularity of Minimally Invasive Surgery, the society’s first laparoscopy workshop is to be or-ganised in the new year, so come on all you Play-Station/ Xbox addicts- prove your natural skills!

»17th noveMber Clinical Skills: Basic Life Support and Suturing workshop.» 2nd deceMber – Lecture: Mr F Haddad, an insight into Orthopaedics & Sports medicine

the next few MonthS:» WInS talk – Mrs Linda de Cossart, Vice President of the RCSEng» Ophthalmic Surgery talk» Laparoscopy workshop» External fixation workshop… and several more too early to say!

Renowned surgeons are frequently invited to spare an evening of their busy sched-ule to share their experience and pro-vide a scent of inspiration, with the aim of encouraging students to con-sider certain surgical specialities.

Last year, the ‘Scrubs and Scalpel’ vol-unteering group was set up, which enabled society members to visit lo-cal schools and discuss the medical course amongst prospective students – many points in the volunteering box!

It’s a busy society, with lots of opportunities available. If you would like us to set up any par-ticular events/workshops then do let us know.

Don’t forget to sign up (£3) at the Union to become an official society member, which gives you dis-counted rates & often priority to the workshops!Keep up to date with all that’s happening by join-ing the mail-ing list or visit-ing the website. * surg-soc@ucl.ac.uk

ü http://www.uclu.org/surgical

hitesh tailoriS SuRgeRy RighT FoR Me?

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Join the facebook group- search “The Bell Maga-zine” or visit www.TheBellMagazine.co.uk

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ü www.thebellmagazine.co.uk* editor@thebellmagazine.co.uk

As you may be aware, a political storm has been brewing over the future of healthcare in the

U.S. To grossly oversimplify, President Obama & the Democratic Party are trying to bring about sweep-ing reforms to the current system, while the Republi-can Party does their utmost to keep things EXACTLY THE SAME AS THEY ALWAYS WERE. After their strong performance in the 2008 elections one might presume this would be a straightforward battle for the party in blue. The President is a Democrat. The Senate is majority Democrat. The House of Repre-sentatives is majority Democrat. Easy right? Right?

Errr… Wrong. However, before we get into the thrilling intricacies of the American political system, let’s take a short look at the ‘unique’ methods by which U.S. citi-zens currently obtain their healthcare. The vast majority of Americans, if they want to get those nasty haemor-rhoids removed, have to stump up the cash themselves (upwards of $1000 a pop last time I checked), or have pre-purchased a medical insurance package that cov-ers the desired procedure. Most rely on the varying de-grees of health insurance provided by their employers,

while a few can afford to pay for it out of their own pock-et. The cost of insurance has spiralled in recent years and this present a huge economic burden, with 16% of the U.S. GDP being spent on healthcare costs and medical debt the leading cause of personal bankruptcy. Whether this insurance is adequate is another question entirely, with large swathes of the population being ‘underin-sured.’ However, 15% of Americans, a whopping 46 mil-lion people, have absolutely no medical insurance at all.

This is clearly a problem.

“15% of Americans, a whopping 46 million, have absolutely no insurance at all”

To be fair, the government does provide a modicum of coverage to senior citizens via the Medicare program, which provides insurance to cover a few thousand dollars worth of procedures a year to those over the age of 65. Veterans are also better supported, with dedicated veteran’s hospitals and ser-vices provided. Nonetheless, a recent study published in the American Journal of Public Health found 44,800 excess deaths per an-num in the United States due to an absence

of health insurance. This may partly explain why the States, despite providing exceptional standard of care to those who can afford it, currently lan-guishes 50th in the world for life expectancy, way behind most of the western world, and preceded by the mighty pacific islands of Wallis and Futuna.

Time to take a look at just what Obama & Co. in-tend to do about this mess. Actually, let’s start with what they’re not going to do. They’re not propos-ing a Canada-style single-payer system, where the government pays private doctors to deal with all your health needs. They’re definitely not propos-ing a UK-style nationalised system, whereby the government itself provides the healthcare, and the doctors, nurses and stool sample analysers are all employees of Her Royal Highness Queen Elizabeth II. What they DO intend to do, alongside a raft of smaller proposals, is to introduce a ‘public option.’ This would be a government provided health in-surance program, available to all, with premiums far cheaper than those currently offered by the private insurance market.

The aim would be to of-fer comprehensive health insurance to those who may otherwise be un-able to afford it, and to drive down the costs of premiums by competing with the private market.

6

The RighT Medicine?The US Health Reform debate explained. toMMy taylor

This is clearly a problem.

To be fair, the government does provide a modicum of coverage to senior citizens via the Medicare program, which provides insurance to cover a few thousand dollars worth of procedures a year to those over the age of 65. Veterans are also better supported, with dedicated veteran’s hospitals and ser-vices provided. Nonetheless, a recent study published in the American Journal of Public Health found 44,800 excess deaths per an-num in the United States due to an absence

of health insurance. This may partly explain why the States, despite providing exceptional standard of care to those who can afford it, currently lan-guishes 50th in the world for life expectancy, way behind most of the western world, and preceded by the mighty pacific islands of Wallis and Futuna.

Time to take a look at just what Obama & Co. in-tend to do about this mess. Actually, let’s start with what they’re not going to do. They’re not propos-ing a Canada-style single-payer system, where the government pays private doctors to deal with all your health needs. They’re definitely not propos-ing a UK-style nationalised system, whereby the government itself provides the healthcare, and the doctors, nurses and stool sample analysers are all employees of Her Royal Highness Queen Elizabeth II. What they DO intend to do, alongside a raft of smaller proposals, is to introduce a ‘public option.’ This would be a government provided health in-surance program, available to all, with premiums far cheaper than those currently offered by the private insurance market.

The aim would be to of-fer comprehensive health insurance to those who may otherwise be un-able to afford it, and to drive down the costs of premiums by competing with the private market.

The most significant of the lesser proposals is an ‘em-ployer mandate,’ whereby employers would be required by law to provide health insurance for their employ-ees, or face severe penalties. These proposals, prima facie, may seem pretty uncontroversial, conservative even. What’s all the fuss about you may ask? Whip up a bill. Budget for it. Vote on it. Pass it. Sign it. Enact it. As mentioned above, it’s just not that easy. There are 3 main hurdles to overcome: The procedural niceties of the sen-ate; the colossal lobbying power of the health insurance industry and, most diabolical of all, right-wing hysteria.

“Interestingly the spo-nataneous outpouring of public feeling was largely

mobilized by corporate lobbying organisations”

You may or may not have heard of Fox News. Imag-ine an all-powerful televisual 24-hour Daily Mail, with the shiniest graphics this side of Transformers and with the ears & eyes of 2,606,000 people a week. Accord-ing to Fox, the reforms are not merely an attempt to widen access & lower costs. They are, in fact, the first step in a Socio-Marxist-Leninist conspiracy to destroy everything that the American people know & love.

A key feature of this has been stoking a fear of ‘death panels’: Bureaucrats plotting to kill Grandma to them, provisions for palliative care & end-of-life counsel-ling to you and me. This culminated in the so-called ‘Tea-Bagging’ of town halls across America, whereby pro-reform politicians were heckled, threatened, and loudly informed they were Communists and gener-ally Very Bad People. Interestingly, this spontaneous outpouring of public feeling was largely mobilized by the corporate lobbying organization, FreedomWorks. The net result of this was an Overton window shift that largely crippled hopes of a bill passing before autumn.

Politics is an expensive busi-ness in America. To fight a political campaign you need money. Lots of it. The bigger the race, the bigger the stash. This money has to come from somewhere. Much of it comes from Political Action Commit-tees (PACs), essentially corpo-rate lobbying firms. The health insurance industry, which un-derstandably isn’t keen on the

public option, is one of the big-gest contributors. For example, the Democratic Mon-tana Senator, Max Baucus, chair-man of the crucial Senate Commit-tee on Finance, has received a career total of $1,848,380 from health industry PACs. It doesn’t take a huge leap to see how some Democrats may be ‘conflicted’ when it comes to deciding whether to vote for the reforms.

So what I hear you say? A 255-178 majority in the House of Representatives? A 60-40 majority in the Senate? Let the turncoats turn, we’ve still got the troops you may say. Getting the bill through the House should be a relatively simple proposition, despite the large numbers of conser-vative ‘Blue-Dog’ Democrats, as only a basic majority is required. However, the Senate is an entirely different beast. Any bill that comes before the Senate floor may be ‘filibustered,’ in effect, talked out of existence. The only way to overcome this is with a ‘cloture’ vote, requiring a 60-40 super-majority. That Senate majority is starting to look a little more fragile, with just one conservative Dem-ocrat needed to break ranks to scupper the whole ship.

The current system of healthcare provision in the US appears unsustainable. It places a huge financial burden at both an individual & national level, and allows a gi-gantic amount of preventable morbidity & mortality to befall American citizens. However, the highly charged political atmosphere in which the reform debate is tak-ing place appears to be obscuring this main point. The final bill may include a full public option, a triggered public option, a soft public option, or no public op-tion but an employer mandate; it could also be forced through using some Very Boring Senate Procedures.

The intricacies of the process, along with the rap-idly changing nature of the debate, mean that any guess as to the likelihood and nature of any bill pass-ing would be distastefully out of date by the time this goes to press. Personally, I wouldn’t bet on get-ting rid of that unpleasant itching anytime soon.

7

toMMy taylor t.taylor@ucl.ac.uK

This summer over fifty runners braved the wind and rain to run ten kilometres through

Regents Park for Médecins Sans Frontières’ (MSF) humanitarian aid work in the Democratic Re-public of Congo (DRC). Staff and students from UCL, Kings College and MSF UK united together to raise money for this worthy cause. Despite bad weather and the lingering effects of post-exam excess, supporters congregated to cheer on the runners. On behalf of UCL Friends of MSF I would like to say congratulations and thanks to everyone involved; the annual event achieved an amazing fundraising total of over £5000.

MSF is an international humanitarian aid organi-sation that provides emergency medical assis-tance in more than 70 countries. DRC is a nation ravaged by conflict, and MSF has been working in the region since 1981. The violence sharply intensified in 2008, prompting MSF to release Condition: Critical (www.condition-critical.org), a website which highlights the ongoing human suffering in the DRC. The money raised will

support MSF’s vital work, including: emergency surgery for injuries including gunshot wounds and burns; mobile clinics to reach those who have fled to safer, more remote areas; epidem-ics like cholera; medical care to victims of sexual violence; and psychological support for those traumatized by what they have experienced.

“the money raiSed will Support mSF’S vital

work”Friends of MSF is the official student-support organisation for MSF based in the UK and Ire-land. UCL hosts one of its longest-standing, most active branches. The sponsored race marked the end of a successful year in which UCL Friends of MSF held several talks and film screenings, and collaborated with the UCLU Live Music Society to deliver a prize-winning Battle of the Bands. Having now become an official UCLU society we hope to do even more in the coming year. A Darfur Week Campaign will be held from 30 No-vember to raise awareness of the humanitarian crisis in Darfur. The 2010 sponsored run will be even bigger, involving collaboration between several London-based universities. A rich pro-gramme of evening events throughout the year will allow participants to learn more about what MSF does and how to get involved.

Find out more:•UCL Friends of MSF website: http://www.msf.org.uk/ucl.friend

•Get in touch: uclmsf@googlemail.com•MSF UK website: http://www.msf.org.uk/

you Can Join the SoCiety at the ClubS and So-CietieS Center, 2rd Floor bloomSbury build-

ing.

8

SponSored race raiSeS thouSandS for democratic republic

of congo

Katherine Pitt

9

Most of us have been there – it’s a Friday afternoon and

all you want to do is go out to the pub with your mates and get a lit-tle bit merry. You certainly don’t expect to end up on a hospital ward with acute liver failure. Ga-reth Anderson, a nineteen-year old from Newtownards in North-ern Ireland, certainly didn’t.

Gareth was critically ill in King’s College Hospital for six weeks, having been told that he did not qualify for a place on the liver transplant list because he had not abstained from alcohol for six months. Unfortunately, Ga-reth did not have six months – he was given weeks to live.

His story has been the focus of a highly emotional media appeal lead by his father, Brian Ander-son. Brian insists that Gareth did not drink more than was normal, and Gareth himself insisted he would “never have another drink in my life”. His Bebo page boasts that he is a “fulltime alcoholic” who is “happiest when the offie opens” which makes his story slightly less convincing. Even so,

he is hardly an alcoholic who has been putting away bottles of spir-its daily for forty years. He was simply acting like a normal teen-ager and had never been admit-ted for an alcohol-related illness before that weekend. Should the six month rule be applied to him?

Firstly, what is the six month rule? The general guideline re-

quirement in many countries (including the US and UK) for someone with alcohol-related liver failure to be placed on the transplant list is six months of so-

briety. The reasoning behind it is simple – donated livers are scarce resources and surgeons will only operate if they feel that the procedure will be success-ful and the long-term outcome good. A significant period of ab-stinence from alcohol would ap-pear to indicate that an alcoholic is less likely to relapse after the transplant and have a positive recovery from the complex op-eration. According to Bramstedt and Jabbour (2005), around 20% of patients with alcoholic liver disease who undergo liver trans-plant continue to drink alcohol.

“to get on the tranSplant liSt you muSt have Six monthS So-

briety”Tang et al (1998) showed that twenty-eight out of fifty-nine patients who survived liver transplant (defined as being alive three months after the op-eration) had drunk alcohol after their transplant, with nine classi-

fied as heavy drinkers and nine-teen as moderate drinkers. The heavy drinkers averaged eight months of post-transplant absti-nence before they started drink-ing again. Five of them had at least one biopsy taken on aver-age 362 days after the transplant because of suspected rejection or unusual liver biochemis-try. Two of these had evidence of fibrosis and fatty change.

Dr Tam from the Ulster Hospital, who made Gareth’s original di-agnosis, was informed by King’s that this rule is “national” and cannot be waived – there are “no exceptions”. However, we should consider whether Gareth’s case should have been so black and white. Professor Roger Williams (George Best’s liver transplant surgeon) maintains that this rule was never meant to apply to pa-tients like Gareth with acute al-coholic liver failure. He believes the guidelines for this condition are far too vague and that the ap-plication of the six month rule to Gareth’s and similar cases is in-appropriate and does not reflect the views of the transplant com-munity at large. Speaking in a radio debate on the issue, he said he believed that both the likeli-hood of abstinence and the pa-tient’s whole life should be taken into account, as is routinely done in other countries such as the US.

Of course, Gareth is not the only patient in the UK to have liver failure. There are currently 382 people on the transplant list and although there is more chance of receiving an organ in time than with kidney failure, some will inevitably not. Many of those on the list will have a condition

Dying for a Drink: ShoulD the Six month rule be waiveD in certain circumStanceS?

rebecca Sloan

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not connected to alcohol or any other drug. The obvious dilemma is wheth-er someone with a self-inflicted liver condition should receive a liver above someone whose liver condition is not the direct result of their own actions.

“Should we puniSh gareth For do-

ing what everyone elSe iS?”

Gareth’s condition was a direct con-sequence of the thirty cans of beer he consumed over those three days, but he did not drink with the knowledge that it may destroy his organs – if he had, he probably would not have dunk to such excess. Can we really fault him for having a particularly heavy week-end when we (as medics who should know better) regularly drink ourselves sick and silly on a sports night or pub crawl? Social binge drinking is a ma-jor health issue in Britain – 8126 calls for 11 to 21 year olds to the London Ambulance Service in 2007-8 in-volved alcohol. Should we punish Ga-reth for doing what everyone else is?

The cruel irony, of course, is that if he had overdosed on paracetamol that weekend in a premeditated attempt to commit suicide, he would have been

put on the waiting list as a priority over all the other people who did not self-inflict the damage to their liver. How can it be that there is one rule for one drug and another for a different one?

As it turns out, Gareth did not need a new liver – after six weeks at King’s he has fought back against the odds and is showing signs of recovery. 22 year-old Gary Reinbach was not so lucky. This July, he died of alcohol-related liver failure after spending much of his teen-age years binge drinking. Is it only the six month rule we should be address-ing? Stephen Nolan, speaking on BBC Radio Ulster, acknowledged that “lots of us have been there, been on benders…go out to drink as much as [we] can” in an attempt to excuse Gareth’s weekend bender. This point is very sa-lient, but

should it be a valid justification? Should it be socially acceptable to go out and get plastered every weekend?

Perhaps it is time to start addressing the growing problem of Britain’s love affair with binge drink-ing as well.

10

The National Health Service has been described as the closest thing we British have to a ‘nation-al religion’. In light of the recent global economic recession, the country’s faith has been put to the test. I will be discussing the problems faced by the NHS dur-ing the recessions, as well as pos-

s i b l e

so-l u -

t i o n s and out-

c o m e s .

Particular wor-ries associated

with the recent eco-nomic downturn re-

volved around fears that public spending on health-

care would be cut. The Nursing Times reported that “the num-ber of nurses in England will be cut by more than [an estimated] 6,500 in the next three years.” This has been acknowledged as a deep concern as there is a known correlation between the numbers of nurses and quality of patient care. Another concern is the re-placement of specialist nurses with general nurses. Somewhat ironically, the NHS workforce has been described as ageing by the UNISON head of nursing. As of last year, more than 200,000 nurses are aged over 50 and due to retire within the next decade.

“Prior to the recession there was arguably real Progress being made...”

In r e -

c e n t y e a r s ,

the NHS has been making

significant in-roads into the gov-

ernment targets aimed at improving healthcare

provision. The average wait-ing times were down (for ex-

ample, outpatients waited an average of 7.4 weeks for an ap-pointment in August 2007 and just 4.6 weeks in January 2009) and access to services was

much improved. A combination of budget cuts and the resulting reduction in staffing levels has lead to concerns that this prog-ress might be in jeopardy. There are similar, negative impacts on NHS staff. According to the UCLH Foundation Trust Chief Execu-tive, every one percent increase in pay from April 2001 onwards would need to be matched with a one percent reduction in staff.

Rates of alcohol and drug use, smoking and depression could all rise as a result of increas-ing unemployment and person-al debt. This naturally results in poor mental and physical health, and a greater incidence of disease. As with many chronic health problems, prevention may be the best cure. For example,

cASuAlTy

cRunchThe recessing NHS

SundeeP Patel

should it be a valid justification? Should it be socially acceptable to go out and get plastered every weekend?

Perhaps it is time to start addressing the growing problem of Britain’s love affair with binge drink-ing as well.

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unemployment benefits could be increased to alleviate financial problems experience by individ-uals. Public health may further be affected by unhealthy eating, brought about by the financial situation; healthy food tends to be more expensive and takes more time to prepare than fast food. ‘Help the Aged’ warned of pensioners unable to pay for heating in the winter, aggravat-ing musculo-skeletal conditions and increasing susceptibility to seasonal diseases like flu. Dur-ing the recession of 1973-74, the government was forced to apply for a loan from the Inter-national Monetary Fund. A con-dition of that loan was to cur-tail public spending, resulting in the abandonment of plans to build and develop District Gen-eral Hospitals nationwide. The difficulties described above con-tribute to an increased disease burden on the NHS, something it may struggle with if there are budget cuts due to the recession.

So, what are the current ideas behind solving this important dilemma? With the NHS such a contentious issue in poli-tics, and with a looming gen-eral election, there are un-surprisingly many ideas as to how to support the NHS.

There are suggestions to end ‘ministerial meddling’ in the NHS by providing GPs with more power and abolishing targets. Under current administration, the number of non-clinical staff has increased sharply, mainly due to the demands of the PCTs. An idea that is being discussed currently in the national press is reducing the number of ‘bu-reaucrats’ in the NHS. Many have suggested that the budget spent

on monitoring targets would be better spent hiring clinical staff, a move that would be popular amongst many. However, gov-ernment targets have lead to a decrease in A&E waiting times and specialist referrals, espe-cially cancer ones, as well as a fall in the levels of MRSA. Other suggestions for cutting costs in-clude freezing pay in the public sector and scrapping IT schemes such as the new NHS comput-er systems and the ID cards.

“a likely PoPular idea is reducing the bureau-

crats in the nhs”

T h e Social Mar-

ket Foundation, in a recent report, outlined the

possible tactics that it argues would be appropriate for the NHS to adopt. These tactics in-clude raising more money; this is politically unfeasible and would have to entail a rise in tax. Greater efficiency in the use of resources is an obvious tactic and would be welcomed by all though it is difficult to achieve in practice. The final ap-proach suggested is to reduce demand for healthcare. This is a method that has already been put into practice by the govern-

ment with increased focus on primary prevention and pub-lic heath scheme. The report also suggests that in order to raise money, an NHS charging system should be implemented on the basis of income, for ex-ample a charge of £20 for GP appointments. Many would ar-gue that this goes against the doctrine and spirit of the NHS, which we expect to be free at the point of use. The co-author of the report argues that fair-ness can only be implemented if the poor and sick received free healthcare and not be sub-jected to long waiting lists and poor service that may possibly result from a shortage of money.

This topic is understandably a very controversial one and a great deal of thought would have to be put in before any major changes are made to the current healthcare system.

There is naturally great con-cern among the general pub-lic and the government as to the imminent future of the NHS and healthcare in the UK. However, there is scope for the management to learn from the past, as well as the capac-ity to improve upon, or at least maintain, recent progress that has been made under the cur-rent government. However, in a time of great economic tur-moil and under a backdrop of the coming elections, and po-tentially a new government, the NHS will undoubtedly have to endure serious changes dur-ing the coming years. Wheth-er this will be for the better or worse, only time will tell.