Feature of the week: What will become of our NHS?

The NHS, the pride of Britain. Free healthcare at the point of delivery, the NHS was established in 1948. The future of the NHS is a common discussion point for many and therefore is also a very likely area to be discussed in medical interviews. People care about the NHS and will defend it to the last word. People care about it and importantly, people have experienced it and everyone has an opinion about it. It is important as a medical applicant to have an opinion on important issues regarding the future of healthcare. However, it is also important to appreciate that when lots of people hold a topic close to their heart, often with very strong points of view, it is important to not go in too strong when asked about it. Discuss it with the interviewer, don't pontificate onto the interviewer because you won't know what their stance is on a controversial topic like the future of the NHS.

A good start is something like, "When on work experience I made a point of speaking to doctors, nurses and other healthcare professionals about their opinion of the NHS. I then also found it fascinating to speak to patients and their families to gain a patient's perspective. It became clear how many people's opinion of the NHS is based on their experience. I think it is clear that many challenges face the NHS and I found a couple of opinions of people I spoke to particularly interesting..." 

This is a safe approach. By going along the lines of 'collecting opinions' when dealing with difficult economical, ethical and controversial issues, you are covering your back. You aren't saying 'THIS IS MY ONE AND ONLY OPINION' but appreciating the importance, demonstrating your interest and showing your intrigue and genuine motivation for the future of healthcare. This is exactly what an interviewer wants to see in an applicant and more importantly, is not going to make any enemies if you go against what the person on the opposite side of the table believes or thinks. 

So once you have broken the ice to clearly make sure you don't come across as a mis-informed know-it-all, what's next? Here Applican will take you through a three pronged approach to answering questions about the future of the NHS that cover important points and allow for further discussion. Easy to remember as well - three points for the three lettered NHS. This is called the Applican NHS Trio Model.


Maybe don't say the word dreamy but this will help you remember it for sure. We all have dreams and ideals. Wouldn't it be amazing if we had excellent free education for everyone, free prescriptions across the UK would be pretty good, get rid of world poverty? Ok the list goes on. Just because something is really good and something we would love to exist, it doesn't make it practical, sustainable or realistic. When the NHS was established it was realistic. The next two points will show the shift in DEMAND and EXPECTATION and how this has changed the practicalities of running a National Health Service - free healthcare for all. The other side to this argument is that many believe that every single thing should be done to make the NHS remain feasible and practical. The question must be asked though - if sustaining an NHS was achievable why is it not widespread across Europe and the world? This point importantly does not question the aims of the NHS, the excellence of its purpose and work and the meaning it holds to people. Instead, it questions the fact that if a dream or ideal is not financially viable within an economy then change is required. The key point is that if demand increases and expectation also increases, more money is required. The more efficient we are, the less of an increase in money is needed - agreed. And it is definitely important to note the many inefficiencies within the NHS - however solving the huge financial challenge of sustaining the NHS with 'removing inefficiency' seems like a bit of a scapegoat.

2. DEMAND IS INCREASING: A shift from acute illness to chronic disease 

When the NHS was established, the life expectancy was lower. People suffered acute illness and the NHS provided treatment for this. The challenges of obesity, cancer and the crisis of our ageing population are examples of chronic disease that are creating  an increasing demand on the NHS. No longer are the problems solvable. They are chronic and therefore sustained expense. Meanwhile technology has transformed the options of treatments for these problems - regularly we hear of new cancer drugs that can extend life for a few more months. We are not belittling the value of these drugs to patients and their families but when a drug costing £90,000 extends life by 6 months, it clearly demonstrates the massive shift in the DEMAND of services and provisions from the NHS by the population. These services and provisions are even more expensive requiring equipment and drugs that are huge costs - the pot is not limitless. 


When the NHS was established, World War II had just finished. Europe was devastated. Death in families was common and those lucky enough to not suffer loss, generally had severe injury - lost limbs, debilitating problems and life would never ever be the same again. A cough, ingrown toenail or a bad cold were not allowed to be complained about. This is not to say they shouldn't be - it is important to follow up on symptoms - as we all know they can be representing sinister problems and can be painful. However, our nationwide expectation for a pain free existence is something only the modern day age has seen. We are hypochondriacs wanting a pain free life and that is not to say this is wrong. It is just to objectively note how patient expectation has been transformed. Whilst this brings huge progress for prevention of the chronic diseases referred to in point 2, it also means people expect more and if the customer, which at the end of the day the patient is to the NHS, requires a higher quality of service then that is realistically likely to cost more and as we said the pot is not limitless.

How to conclude...

By discussing the Applican NHS Trio Model and even better referring to examples you saw on work experience or discussing with doctors and patients then the above points will allow you touch on lots of things. The absolutely KEY point is that the media and common discussion is often about how the NHS is doomed. However, maybe the NHS is not over? Perhaps, it just requires change in order to meet the shifts we have discussed. And what does change require? LEADERS. Tomorrow's Doctors need to be leaders - yes at the level of the healthcare team for the best for patients but also to lead healthcare SYSTEMS in the right direction. So how do you make a good leader? Tell the interviewer about your leadership experience and skills! 

This makes a good conclusion to this topic. You have discussed ft he challenges, appreciated important opinions and points you observed and heard. But you are a motivated individual - excited to make it work. Excited to contribute to the medical advancement of the next generation. Excited to contribute. So leave on that point. Aware, realistic but ambitious and innovative. Exactly the sort of student a tutor wants in their medical school. 


This feature is an example of the discussion topics covered in the 2 day Applican courses running across the UK. The next course is taking place in Belfast on 29-30 August with more courses running in September. Book your place on www.applicancourses.com/book or email applicanuk@gmail.com for more information.   


What will become of our NHS? 

What will become of our NHS?