Another NHS scandal erupts.  Last week serious criticisms of  St George’s Hospital heart unit were made by Professor Berwick who had been asked to undertake an investigation to the department when unusually high death rates were detected [3.7% for cardiac surgery compared with 2% nationally]. He declared  internal scrutiny was  “inadequate” and the department was riven between “two camps” exhibiting “tribal-like activity”. He commented further saying  “Some felt that there was a persistent toxic atmosphere and stated that there was a ‘dark force’ in the unit.” Conversations with staff revealed they were shocked by the death rate, but “most felt that poor performance was inevitable due to the pervading atmosphere”. Two surgeons have since been suspended from their posts but sources allege that these were surgeons who, rather than being responsible for the problems, highlighted them and attempted to blow the whistle on problems at the unit and have thus been victimised by the management at St Georges [St Georges denies this].

Whistleblowers are people who bring attention to the failings of the organisation they work for. They have been described as a combination of hero and disloyal sneak, which illustrates exactly what a difficult position they are put in. They are rarely popular, are denied promotion and often have to sacrifice their careers. The scandal at Mid Staffordshire NHS Trust was one of the last major scandals in the NHS. About 500 people were estimated to have died of negligence and appalling standards of care as a result of cost cutting by management. It emerged that staff who tried to bring the crisis to the attention of their superiors were bullied into silence. Sir Professor Brian Jarman of Imperial College heads the health analytical company Dr Foster which looks at hospital statistics [It was the statistical analysis from the Dr Foster unit at Imperial which first led to questions being asked about the standard of care at Mid Staffs] he stated that the NHS still continues to foster ‘a culture that allows suppression of the truth and victimisation of whistleblowers.’ Carol Parkes wrote in the BMJ at the time

If no one dares to ask the unpopular questions and everybody keeps their heads down, the organisation can succumb to poor thinking, poor strategy, and poor leadership.’

The GMC states ‘make the patient your first concern  Whistleblowing is an obligation. A doctor can be struck off the GMC registrar if he fails to report concerns. Patient care and safety should be a doctor’s primary concern. If you don’t report such matters you may not be an abuser but you can be viewed as a collaborator. It is always hard to speak out against your colleagues and employers but it is essential.

whistleblowers cross

NHS staff have the knowledge and the understanding to know when care is not being properly provided by their organisations. Patient feedback is valuable but enabling staff to speak up about faults within the NHS is probably more important in the effort to improve the NHS than employing countless expensive management consultants. The Francis Report into Mid Staffordshire stated that junior doctors [who frequently move posts as part of their training schemes] and are less inured or entrenched in the ways of working of departments ‘are the eyes and the ears of the NHS.’  In my local area the CCG has a  ‘MAD’ button on its website which stands for ‘Make A Difference’. Clinicians like myself press it if we feel there is a problem with care and I am pleased to say it is investigated.

Numerous scandals over patient care have occurred over the years. We had the Bristol Heart scandal in which incompetent surgeons operated on babies [the anaesthetist who reported it to the press had to find work in Australia], the Winterbourne Home scandal  and Mid Staffs. NHS staff spoke up in all these cases but were not listened to! More needs to be done to protect the whistleblower!




Matt Hancock – Our our new Health Secretary.


2015 General Election - Cabinet

Matt Hancock was appointed minister for Health and Social Care replacing Jeremy Hunt who was promoted to foreign secretary. Like Jeremy Hunt and David Cameron he studied PPE at Oxford, before studying economics at Cambridge, then went on to work at the Bank of England before becoming George Osbourne’s [the previous Chancellor’s] chief of staff.

Earlier this year he was appointed Minister of State for Digital and Culture and in January 2018 became Secretary of State for Digital, Culture, Media and Sport. He launched his own smartphone app which a privacy watchdog called ‘a fascinating comedy of errors’ after the app was found to collect its users’ photographs, friends, and contact information breaching privacy laws.

Health professionals are concerned that like Jeremy Hunt he had no real experience of the NHS before becoming health minister. Jeremy Hunt once wrote a pamphlet supporting denationalising the NHS and suggested replacing it with “universal insurance.’’ Matt Hancock has received a total of £32,000 from an anti-NHS think tank in the past. He used one of his first speeches to praise Babylon, a private company’s virtual GP service saying that he no longer has an actual GP but uses their face time service. Babylon provides services to the NHS as GP at hand and allows patients to register with them instead of a normal GP. It provides the vast majority of consultations online/facetime and states that those with mental illnesses, long term chronic conditions or are pregnant are not suitable. GPs are paid on a capitation basis, per patient rather than per attendance so doctors’ leaders have criticised this development as it ‘cherry picks’ the young and fitter patients leaving the more complex and time consuming for other GPs in the area and risks destabilising GP practices that depend on ‘fitter’ patients to ‘subsidise’ their services. It is an unfortunate coincidence that politicians in charge of the health service tend to be well off and healthy men and represent those least likely to use and need the health service. They tend to bring about changes that they would like to see such as easier access whether by phone or by having out of hours appointments and hospital services [David Cameron wanted to introduce a ‘seven day NHS’ providing routine care all week and this led to the Junior doctors strike and friction with other doctors]. In other countries such as Canada the Health Minister is usually a health professional. Dr Sarah Woollaston a Conservative MP and chair of the Commons Health Select Committee would be an excellent one.


Exercise the wonder drug!




A study published this week and reported on by several national papers concluded that women who exercised in middle age had a reduced chances of dementia by as much as 90% compared with those who took no exercise. This was a population-based  prospective cohort study on women in Sweden which recruited women in 1968 and followed them over 4 decades.

These findings have give further proof that exercise should be regarded as ‘a wonder drug’.

If there was a treatment that could lead to the following;

  • up to a 35% lower risk of coronary heart disease and stroke
  • up to a 50% lower risk of type 2 diabetes
  • up to a 50% lower risk of colon cancer
  • up to a 20% lower risk of breast cancer
  • a 30% lower risk of early death
  • up to an 83% lower risk of osteoarthritis
  • up to a 68% lower risk of hip fracture
  • a 30% lower risk of falls (among older adults)
  • up to a 30% lower risk of depression

we would all be taking it, wouldn’t we? Well there is and it is called exercise. These figures were correct when people were randomised to 150 min a week of aerobic exercise [so they got sweaty and out of breath] or continued to do nothing. And this was true even if people did NOT LOSE WEIGHT. Most people generally know that exercise is good for the heart but few realise it has an effect on the immune system and leads to a decreased risk of some cancers such as cancer of the breast, colon, womb and even possibly lung cancer.

It is as good for depression or anxiety as counselling or anti depressants. When you exercise you ‘burn off stress hormones’ and get an endorphin [‘feel good’ chemical] boost. Feeling fitter, stronger and more attractive obviously wards off and prevents depressive feelings.http://www.rcpsych.ac.uk/expertadvice/treatments/exerciseandmentalhealth.aspx

Exercise relieves stress

We are all likely to live longer and the incidence of dementia will increase. How do we try and prevent this – with ‘brain training’ games? There is no evidence that these work – however the general maxim ‘What is good for the heart is good for the brain’ does hold. Much dementia is caused by atherosclerosis – furring up of the blood vessels to organs such as the heart and the brain. As the blood supply to the organs reduces they can not work so well and cells may die – in the case of the brain this leads to dementia. Alzheimers involves the formation of amyloid plaques in the brain. Cholesterol promotes the formation of these plaques.


Half an hour of exercise a day is probably more beneficial for my type 2 diabetic patients than all the multiple, expensive medication [with side effects] that they are on!

Figures published a few days ago by the NHS’s Health and Social Care Information Centre suggested that two thirds of men and half of all women are now overweight or obese. Only a third of adults manage 30 minutes of exercise once a week. It seems that the British are now the fattest in Europe!

What can we do about it? This week the BMA demanded a tax on sugary drinks and a ban on unhealthy food adverts targeted at children. This of course raises questions about the infringement of personal liberties. But in this country and others such as the USA and Denmark, which have introduced similar legislation, there is the growing realisation that unless we do some thing and try and tackle our unfit, overweight population our health systems might not be able to afford the consequences.diabetes ad

As a GP I promote exercise for it seems most disorders – from diabetes, menopausal hot flushes [helps temperature regulation and maintains bone density], to insomnia [promotes natural relaxation and sleep]. I often write a very simple exercise plan on a prescription to emphasise its value as a treatment. I refer the overweight to dieticians and gyms [they can attend for free – courtesy of the NHS] but doctors and dieticians get notoriously bad results – hence the rise in gastric bypass operations. Many have argued that we should pay people to lose weight and exercise, give them a monetary incentive and this would be far cheaper in the long run for the NHS. Some health bodies have already tried this. What do you think? Is this a step to far?

May be you agree instead with the solution in the cartoon below. -please feel free to comment.


obesity cartoon

Obesity, health and fat shaming.

obesity cancer research

Obesity has been in the news. Millennials have been declared the fattest generation ever and Cancer Research UK adverts have caused controversy for ‘fat shaming’ and ‘promoting eating disorders.’

Obesity seriously increases the risk of many diseases including breast cancer, bowel cancer, cancer of the womb, type 2 diabetes, strokes, heart disease, joint and muscle problems.  Only a third of adults manage 30 minutes of exercise once a week. It seems that the British are now the fattest in Europe!

Childhood obesity is a major problem in the Western world. The vast majority of obese children become obese adults. About 60% of children in the USA and 50% in the UK are over weight or obese.  These children will have major health issues and often psychological problems. They are not only deemed to be less attractive than their peers but less intelligent and lazy with poor will power. No wonder self esteem issues are the norm. Fat adults are likely to be less successful in their career and are passed over for promotion. However studies in the USA have shown that 75 % of parents of obese children do nothing about their child’s weight problem. The editorial of the journal of the Royal College of GPs quoted the UK National Child Measurement Programme which found that 79% of parents of overweight children do not recognise this fact and of those that do only 41% perceive this as a health risk. The state of Georgia in the USA has run a series of hard hitting adverts to try and change attitudes – see ads below.

childhood obesity ads 2

Critics argue that this is further stigmatising fat children and adults and will increase bullying. As a GP I have had a number of difficult consultations with patients. As a doctor I feel I have a duty to tell them that their weight is probably contributing to their suffering and long term health. Last week I explained to an overweight patient with backache and knee pains that her joints and muscles were having difficulty trying to support twice the weight they were meant for; that it is like carrying a grown up person around all the time and she would feel so much better if she could lose weight. The patient reacted quite angrily and told me she had come to terms with her weight and she objected to me raising the issue. Commenting on weight has become an ethical and social mine field that reflects the stigma and psychological suffering as well as physical suffering that is a consequence of being overweight.

anti anti obesity ads

Assisted Suicide


assisted suicide

The BMA and the key medical royal colleges remain opposed to assisted dying. It is claimed by supporters of assisted suicide that they are out of step with the public, 80% of whom are in favour. According to polls they may also be out of step with the doctors they represent. A BMA poll asked whether doctors agreed that assisted dying should be made legal in defined circumstances. 55% agreed or strongly agreed with the proposition. Forty three per cent were against.

An editorial in the BMJ last week stated  ‘Ultimately legalisation for assisted dying will be a decision for UK society. The job of the BMA will be to contribute to the debate, not find itself sidelined because of its implacable opposition. Its members, and our patients, deserve better.’ It was recommended that doctors are polled again as there seems to have been a shift in medical opinion and the BMA and colleges take a neutral stance on the issue.

Assisted suicide is in the news a lot and is often the subject of ethical scenarios at medical school interviews.

1.‘Thou shalt not kill’ is one of the oldest moral commands. It has been a key part of medical ethics for centuries. The original Hippocratic oath states ‘I will give no deadly medicines to anyone if asked, nor suggest any such counsel.’ Many religious people contend that only God has the right to give or take life.
2. Those that are infirm may be pressurised to die or made to feel selfish or a burden if there was this option.
Slippery slope arguments. The ‘slippery slope’ argument holds that if assisted suicide was practised for people like Mr Nicklinson [a man with locked in syndrome who was refused help to kill himself and eventually had to starve himself to death] then it would become acceptable to allow it for less clear cut cases and eventually you may end up with a situation as in Nazi Germany where those deemed to be defective were killed.

assisted suicide - the slippery slope
4. With good pain control and counselling, suffering will be minimised.

Arguments for assisted suicide:
1. The person’s right to autonomy, control over his or her life. According to polls most people in the UK feel that they should be able to have some control over when and how they die. In many philosophical traditions ‘egoistical suicide’ [death for one’s own reasons such as to avoid pain] is considered selfish and wrong. However the aim of ‘altruistic suicide’ which is carried out for the love of others or for the religion [eg Jesus praises a man who lays down his life for others [John 15;13] ] is more acceptable to most religions. It can be argued that someone who wishes to die in order not to be a burden is following the same principles.
2. Some, such as Debbie Purdy, who had multiple sclerosis, have argued that if her husband faced prosecution for helping her to commit suicide she would travel to Dignitas earlier while she could do so alone. However if the law permitted her to have help she would delay dying.
3. Even with the best palliative care [treatment of the dying] suffering and pain are common. Dr Ann McPherson, who set up the charity and website ‘Teenage Health Freak’ and supported a change in the law on assisted dying, died from pancreatic cancer. Her daughter wrote in the BMJ ‘our mum died slowly and in pain. …The law needs to change to allow terminally ill but mentally competent people the right to a more dignified death than my mum’.

Active euthanasia is when death is brought about by an act – for example when a person is killed by being given a deliberate overdose of pain-killers.
Passive euthanasia is when death is brought about by an omission – i.e. when someone lets the person die. This can be by withdrawing or withholding treatment. Eg stopping a ventilator.
Active euthanasia is illegal while passive euthanasia is legal. ‘Thou shalt not kill but need’st not strive officiously to keep alive.’ [Arthur Clough 1850’]. It has been argued that often the moral difference between acts and omissions is tiny. The Catholic Church for example sees no difference between the two – ‘The act or omission which, of itself or by intention causes death in order to eliminate suffering constitutes a murder.’ [Catechism of the Catholic Church] NB In common language euthanasia is often used to mean active euthanasia.

What society thinks is usually reflected in the laws of a country. Assisted suicide is presently illegal but the view of the general population seems to be shifting with about three quarters of the population now reportedly backing assisted suicide. This is reflected by the lack of prosecutions of those helping loved ones go to Dignitas [the clinic offering assisted suicide in Switzerland].‘The law has a stern face but a kind heart’ is how Baroness Finlay described the present situation. However Lord Falconer has said:
‘No one has the stomach to enforce the current law, because it is inhumane and further provides no protection for the vulnerable. The threat [of prosecution] forces some people to die alone and earlier than otherwise for fear of what may happen to those who accompany them.’

The Director of Public Prosecutions was asked by Debbie Purdy a multiple sclerosis sufferer under what circumstances her husband would be not be prosecuted if he helped her travel to Dignitas. He produced a set of guidelines in 2009 in which he stated that the patient had to have shown that they had come to a ‘clear, settled and informed decision’ to commit suicide and that the loved one who aided them was entirely motivated by compassion.

Medical Manslaughter – Bawa Garba



One of the pictures posted on News about #Bawa Garba

Doctors are outraged.  Thousands of medics have signed petitions, last weeks BMJ talked about a culture of fear and blame,a prominent cardiologist has referred himself to the GMC and suggested others to do the same. The GMC responded by emailing all registered doctors and the heath secretary today promised to order an urgent review in to the issue of medical manslaughter. Why?

The GMC went to the high court to erase Hidiza Bawa Garba a junior doctor training in paediatrics from the medical register. She was convicted of medical manslaughter for the death of Jack Adcock a small 6 year old boy. The Daily Mail took it further and demanded that she be jailed.

A look behind the cover story shows however that there were a catalogue of alarming facts which to an unsafe working environment in which mistakes could happen to the best of doctors. She had just come back from 13 months maternity leave and had not had an induction, she was unfamiliar with the hospital and the 6 wards on four different floors she was supposed to cover. She missed the hand over ward round that morning because she had to attend to a cardiac arrest and was therefore  completely unfamiliar with the patients. The consultant on duty that day was absent [he was lecturing on a different site] as was the other registrar, her paediatric SHO had been told to go down to the lab for a few hours and collect results as the hospital IT system was not working . She was doing the work of  4 doctors. She had not eaten or drunk anything all day.  Jack’s parents had given the little boy a drug, enalapril without telling the medical staff, it was not written up on the drug chart and it was not recorded. It lowers blood pressure and made it more likely that he went into cardiac arrest. Dr Bawa Garba wrongly mistook Jack for another boy because he had changed beds and thought he was not for resuscitation so halted it after a few minutes [this however was not thought to have made a difference. Jack was already too far gone.]

Professions concerned with safety such as pilots and medics talk about the Swiss Cheese Model where a catalogue of  problems leads to a disaster. Normally the holes in Swiss cheese do not line up but occasionally they do. It is not usually a single error made by one person but problems in the environment and therefore changes in the environment and checks and balances can lead to improved safety. Air safety has improved substantially using this attitude.

The judgment of the senior judges in this case has caused confusion and outrage. Justice Ouseley acknowledged that Bawa Garba  ‘before and after the tragic events was a competent, above average doctor’ but also stated that the events were something she had been trained to cope with.  He shows a complete misunderstanding of the work of doctors. No amount of training can enable you to do 4 doctors work. My job in paediatrics involved being on call and covering 4 wards [the labour ward, post natal ward, neonatal unit and casualty]. I clearly remember one day when  I was the only paediatrician in the hospital and was treating a severe asthmatic finding it hard to breathe when a 16 year old girl was brought in unconscious [later found to have had a subarachnoid brain haemorrhage] and I was fast bleeped to also attend a baby who had just been born and was not breathing all within minutes.  I hoped things had improved but sadly the NHS seems to be being squeezed and shortages are common. Justice Ouseley, you cannot be in 3 different places at the same time.

What is also concerning is that as doctors we are encouraged to reflect on how we can improve our performance. It seems that Dr Bawa Garna’s reflections were used as evidence against her. This has led to calls to boycott the reflective portfolio that all trainees write and doctors some doctors are stating that in this current culture it is unwise to admit mistakes. Consultant cardiologist Peter Wilmhurst, a prominent campaigner for transparency and safety in medicine has referred himself to the GMC because he says that over four decades of practice he must have made mistakes some of which would have led to the deaths of patients, and he has encouraged other doctors to do the same. Doctors now fear that they will be made scapegoats when systems fail. Hence the campaign #I am Hadiza.



Baby’s life-support ‘can be stopped’


Isaiah Haastrup and aunt

Doctors can stop life-support treatment to a brain-damaged 11-month-old against his parents’ wishes, a High Court judge has said. Isaiah was born with brain damage after a difficult birth during which his brain was starved of oxygen. King’s College Hospital wanted to give only palliative care to Isaiah Haastrup because he needed continuous ventilation and showed no awareness of his surroundings because of his severe brain damage and felt continuing ventilation was   “not in his best interests”.

Isaiah’s mother, Takesha Thomas said ‘I see a child who is injured. He needs love. He needs care. I have it. I can give it,” talking about his life she said  ”To say it is so poor, it is not worth living, that is not right. It is not their decision to make.”

Parents often believe they have the right to decide what happens to their child. However that is not strictly true in law and according to medical ethics doctors have a duty to do what they think is best for their patient, the child. If it is an emergency they may treat the patient against the wishes of a parent for example. When ever possible if there is time however they will make a child a ‘ward of court’ and a judge will decide.

Barrister Fiona Paterson, representing King’s College Hospital NHS Foundation Trust, said nobody could understand the pain and suffering Isaiah’s parents had endured. However, she said overwhelming medical evidence showed stopping treatment was best for Isaiah.

Mr Justice MacDonald said he passed his ruling that Isaiah’s life support should be switched off  with “profound sadness”.

Children and consent;This case raises ethical issues of consent and autonomy. Adults have autonomy and the right to make bad decisions for themselves. Steve Jobs of Apple refused to have surgery for his pancreatic cancer when it was first diagnosed, preferring macrobiotics and positive thinking despite the pleas from his doctors and family to have the standard conventional treatment [he later fully embraced what ever medicine could offer him and underwent two liver transplants]. Seven year old children do not have autonomy so usually their parents are regarded as being guardians of their best interests. However when this seems not to be the case, doctors/hospitals can apply to court and the child can be made a ‘ward of court’ and decide what is in the child’s best interest. The court has to decide what would be in the child’s best general interest not necessarily the child’s medical best interest.  So this is usually only done for severe life threatening illnesses. For example I know of a case of a Jehovah‘s witness boy who was recommended a blood transfusion but whose parents refused it. The boy was instead given iron injections [which are notoriously painful] over several months  because although a transfusion was in the boy’s medical best interest it was thought that this would endanger how his parents felt about him and injections would be in his overall best interest.

Blue Monday and resilence


Today is ‘Blue Monday’ supposedly the most depressing day in the year – originally thought to be the 3rd Monday in January. It was probably first suggested by Cliff Arnail. His equation has six factors:  debt (d), time since Christmas (T), weather (W), low motivational levels (M), the feeling of a need to take action (Na) and time since failing our new year’s resolutions (Q).

blue monday equation

Although I am not sure how scientific this all is it certainly seems to fit in what we see as GPs and counsellors seem to be busiest and booked up in January.

Of course stress is not limited to just one day a year. It is just that it seems to peak about now. Christmas often brings us face to face with realities of family life [divorce lawyers have their busiest month], credit card bills start arriving and the optimism of the New Year and new year resolutions start fading.

For students, January often means mid-year exams.  Students have left the cosiness of home where they have usually been looked after and return to essay deadlines, exams, doing their own cooking and cleaning etc. First years have got over the excitement of starting University and second and third years have the pressure of knowing that all marks contribute to their degree grades. The short days and the darkness make it hard to get up in the morning and to motivate yourself. Some people do suffer from SAD, seasonal affective disorder where a lack of light can lead to depression.

Stress, anxiety and depression are very common anyway. A new report published a couple of days ago by ICM claims that 55% of interviewees said that stress caused by their employment has an adverse effect on their mental health and day to day life. As a GP 1 in 4 of my consultations are about stress, anxiety and depression. That is far more than any other condition, including all respiratory infections such as ear, throat and chest infections combined!

Medical Schools repeatedly remind interviewers that students and doctors who fail and cause concern do so, not because they are not clever but usually because of stress and a lack of ‘emotional resilience’. The medical course is long, intensive, full of exams and students and doctors constantly see distressing events. Empathy is important but it is always important to keep a professional distance and take care of yourself.  Therefore many candidates if not most, will be asked questions on how they cope with stress or how do they think that they would manage a heavy workload and extra curricular activities.

By now you should have evolved ways of learning, dealing with exams,managing your workload  and developed ways of relaxing. To avoid feeling overwhelmed some people make lists, it is important to prioritise tasks,delegate or even cross off tasks further down your list.  It is difficult but sometimes necessary to be assertive and to speak to people who have unrealistic expectations; for example a teacher who seems to ‘forget’ that you have other subjects apart from hers. Managing time effectively, (using travelling time to read the student BMJ or this blog for example!) is important. Demonstrating self discipline e.g. by getting up early before school for rowing practice would be worth mentioning. It is also important to have ways to unwind. Exercise is a great way of burning off stress hormones and boosting endorphin levels, as is music and singing. True friendships areinvaluable and bring a sense of self worth. And anyone having difficulties should seek help as soon as possible and realise there is no shame attached to this.Macho – ‘I can cope’, ‘soldier on’ attitudes are very much frowned upon.

Winter Crisis

A and E images 2

ambulances outside hospital  A and Es which are full of patients waiting to be found beds on already full wards

With winter comes the cold and therefore more illness. This puts a strain on the NHS. The NHS has a budget of £116.4 billion annually, this is only 8.5% of the UK’s GDP and is much less than the amount that is spent by the other G8 countries. For example, France and Germany spend 11.5% of their GDP on healthcare, this is almost 50% more than the UK. The USA spends over double this amount spending 18% of its GDP. With the strain of what many would consider to be an inadequate  budget on the NHS and the demand for healthcare increasing, winter brings many problems and pressures.

In the NHS bed occupancy is high. The UK has 2.61 beds per 1000 people compared with 6.1 in France and 8.1 in Germany per thousand people. Bed occupancy runs over 90% in the UK, this means that in the busy winter months it often runs over 100% causing patients to be left in trolleys in corridors or transported hundreds of miles to find a suitable bed far away from families and friends.'I only got up for a drink of water, and a queue's formed next to my bed.'

A problem is ‘bed blocking’. This is the long-term occupation of hospital beds, usually by elderly people, due to shortage of residential and nursing home places. Councils often have to fund such places and carers at home and their budgets for social services have been cut. While the patient is being looked after by the NHS that patient is not a drain on their budget. Many propose combining health and social care so there are no longer separate budgets and there is better coordination.

General practice is at present underfunded and there is a shortage of GPs. GP workload has gone up and GPs now carry out 50% more consultations than they did 10 years ago this still does not satisfy demand and getting a GP appointment is difficult and some people go to A&E instead. 90% of all treatment in the NHS occurs in general practice. A decrease in capacity of 10% in general practice can lead to an increase in the A&E departments of 50 -100%.

In winter  infectious diseases such as flu and pneumonia  are more common. Heart attacks and strokes are also more common in winter due to the extra stress the cold can put on the body. There has been an increase in reported flu cases over the last couple of weeks.

The NHS like any healthcare system in the West is under pressure due to increasing medical technology and expectations, an ageing population and obesity.  The NHS generally does well, the World Health Organisation and The Commonwealth Institute (a well regarded American think tank) have both recently declared the NHS to be the most egalitarian and efficient healthcare system in the world but of course it is under pressure particularly in winter and the gaps become more apparent.


Goodbye 2017

Image result for science march

There was a depressing start to 2017. It felt that science was had been given a shove backwards. Science itself  seemed under attack. Politicians in Britain declared that ‘People have had enough of experts’ and Donald Trump tweeted ‘Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!’  Robert Kennedy Jr, a prominent vaccine conspiracy theorist was appointed to chair a commission on “vaccination safety and scientific integrity”.  Scientists, medics and statisticians who actually understood data, it seemed had no place.  The new anti vaccine film ‘Vaxxed’, directed by discredited anti-vaccine activist Andrew Wakefield who was struck of for fraudulent research and unethical behaviour was given publicity by major channels such as Fox News.

Image result for science march


The Trump administration carried out the the freezing of research grants, and a gag order was placed on scientists in the EPA regarding dissemination of their research findings. In February 2017, William Harper a Trump science adviser with described  climate science as “really more like a cult” and its practitioners “glassy-eyed” This led to the Science March on April 22nd  to protest against ‘The misrepresentation and exclusion of scientific knowledge in policy decisions.’

Image result for science march


Despite the bad start to the year and despite politicians, scientists have made astonishing progress. We seem to be on the cusp of amazing advances in the field of genetics. Research and techniques such CRISPR-Cas9 has made the transformation out of the lab and in to clinical practice and genetic disease are being conquered at a breathtaking rate.

Image result for embryo editing crispr

Haemophilia A

Image result for haemophilia a

This disease is caused by a genetic defect that means those affected do not produce a protein – factor 8 needed to stop bleeding. They need expensive injections with factor factor 8 twice weekly and suffer painful bleeding in to joints and skin and gut frequently. Thirteen patients were given the gene therapy at Barts Health NHS Trust. All are now off treatment with 11 producing near-normal levels of the protein.

Sickle Cell

Image result for sickle cell anaemia

A French teenager’s sickle cell disease was reversed using similar treatment to change his DNA. A virus was used to infect the bone marrow with new, correct instructions so it made healthy red blood cells. So far, the therapy has worked for 15 months.

Butterfly Children

These children have junctional epidermolysis bullosa – a genetic condition in which the epidermis [top layer of skin] does not stick to the dermis. This leaves skin as fragile as a ‘butterfly’s wings’. Few children live past their teens. Hassan was being treated with palliative care. A piece of his skin was taken, its DNA was repaired in the laboratory and the modified skin grafted back on. After nearly two years, the new skin appears completely normal.

Bubble Baby Syndrome cured

Three babies are born each year in the UK with an immune deficiency condition which leave them at constant risk of developing life-threatening infections. If left untreated, infants need to be kept isolated from the outside world, which is why the condition is known as “bubble baby syndrome” and usually die before school age.

NICE has agreed that NHS will fund gene therapy for the first time, with a £500,000 treatment for “bubble baby syndrome” produced by GlaxoSmithKline. One treatment is enough to produce a life long cure.

Embryo editing

Image result for embryo editing crispr


Scientists have, for the first time, successfully freed embryos of a piece of faulty DNA that causes a deadly heart disease to run in families. 10,000 of different genetic disorders  are passed down the generations . The US and South Korean team allowed the embryos to develop for five days before stopping the experiment. Gene editing Crispr was used to make precise changes to the genetic code. Its applications in medicine are vast and include the idea of wiping out genetic faults that cause diseases from cystic fibrosis to breast cancer.


This autosomal dominant genetic disorder lead dementia, movement disorder and death.  The disease is caused by an aberration in a section of DNA called the huntingtin gene. The error corrupts a healthy protein and turns it into a killer of brain cells. Epigenetics – is the science of the reading of genes. What makes cells to read some genes and ignore others. Epigenetic manipulation has been used to silence the huntingtin gene by blocking the messages it sends to the cell’s protein-making factories. This could be the first treatment to slow or prevent any degenerative brain disease. UCL is conducting trials at the National Hospital for Neurology and neurosurgery in London. 46 patients had the drug injected into the fluid that bathes the brain and spinal cord [cerebrospinal fluid].  This human trial showed the drug was safe, well tolerated by patients and crucially reduced the levels of huntingtin in the brain.

Truly exciting – what will 2018 bring?