Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello. Everybody in. Good evening. I'm just waiting for confirmation that you can call here. May I have a planted someone in the group who can confirm or deny this? I'm just waiting for them to confirm. Or tonight. Hello. Good evening. And welcome to the first session off the atrial healthcare Siris. Um, there was a little bit with this one. We're still trying to figure it out on, but not 100%. Uh, sure. How everything works. Just a the moment. Start this one. I don't think we have a moderator for the chapped for the moment. So it means that questions may take a little while to get processed while we continue to poke someone to join from the team in order to be out of questions. But they will be answered. Just rest assured of that one. Just for the moment, I can't see them. Anyway, let's begin. So, uh, hello and welcome second one, which will be myself doing the history of medicine on Then it will be followed by Josh doing structure of image s I'm for relevance. That's what we look like. Um, both of us are instant on ambulance. Since we're in synch John uniforms for the photos. Just brief introduction myself. Most. Freddie Cooper. I'm currently a third year in undergraduate medicine at G. Katie Med School, which is part are what? Which is part of King's college London. Um, Josh, when he comes in to teach later, I'm sure he'll introduce himself well that he's just entered. It's final year of medicine Imperial also in London. So there, again is are sort of brief overview of everything going on. I think hopefully everyone seen, uh, this line up before I was putting in here just for relevance on then. Any queries, please? Email. May I've had quite a few. So far so good with it from a bit slow with, um um, but I will get around to answering everyone. Uh, if well, that's time permits. Yeah, Please do email me any questions, queries or suggestions for future sessions, and I'll mention that bit more towards the end. Uh huh. So about over do today we're going over history of medicine should really be called history of healthcare, but that, like it's a bit brought this session off. C is not all inclusive. It's not everything you're 11 need to know what the topic. It's some particular highlights and general interest elements. Um, why is this useful and wise? It's necessary, depending on what university you go to in depending what course you take. Some of them like to throw a lot of history at you myself. That kings in first year we had a and tires off part of a module think it's like 15 hours elections relating to the history of medicine, sort of where doctors come from less sort of stuff. It's also just quite interesting. I'm going to start this session off with a couple of treatments on. Decisions have been known for generations some of the oldest known procedures on day treatments from healthcare, which I think it just interesting that all still in circulation today on. Then I'll go through a bit of sort of wear. Different elements of healthcare come from including, I think, the birth of the university, really. So we'll start off with. I'll give a don't think there's any particular goal, but I will warn you. I think there's a picture of a skull and a bit later on, there's a picture of a leech. Other than that, it should be fairly nice and lindane last year old. That's your pre warning. For anything gory, we'll start with panning. Self See, Here's another scope, and in a topless head, it's got some nice holes that aren't meant to be. That makes a little bit like a bowling ball. Japan. An ultra pronation is the process of making a hole in the skull, one that wasn't meant to be there in order to relieve pressure. We still do this. These days. It's quite rare. It's still very useful in certain conditions, anything that basically involves excess pressure under the skull. As you can imagine, your skull doesn't move a lot. It's a quite rigid, bony structure. It's quite a lot going on underneath that. You got a brain under there. I hope you've got a little blood flow under there. On defense, thing goes wrong, there's there's no a lot of space for it to fill, so stuff starts to swell inside the head. It can expand on anything, cause quite a lot of pain. And it caused a lot of damage to panning and trepidation are supposedly one of the oldest known medical procedures. Certainly the oldest known that it's still in circulation today. There's evidence within skulls about 12,000 years old, which is pretty old. They so it's it's sort of thought to be potentially. The first known surgical procedure certainly is the first evidence of all. Surgical procedure always is quite easy to evidence. Trepidation because you can find a skull with a hole in it and go what? That's what happened here. Things on the soft tissues don't tend to survive 12,000 years, so there could be other ones out there. This is a very basic one. Is a very old car ever exactly where I got this picture from, but of someone having it done in what looks probably medieval, slightly premature, baby. Originally, there was this off intention. You thought the pain was related to spirits. We'll talk about later on about how people sort of thought things like that came about and the idea what he was releasing. That which is not entirely wrong. The pain is coming from a buildup of pressure and your relieving the pressure. So if you don't really understand physics, you could sort of understand why people might blame it on spirits. Survival rates were pretty poor because ultimately you're drilling a whole in someone's head. All sorts of stuff you don't want inside the head congestion there also infections it. Also, if you're using a bit of rock or a bit of metal to do this, you probably not cleaned it, and they love it is also you're jamming it into someone's head. It is quite difficult to know when you've gone too far on a potentially drilling into brain matter. Um, we still do this today. This is a video film we were made to watch, actually, part of my philosophy of medicine and I would recommend it to anyone interested in any sort of healthcare is actually really interesting Video film. It's about a British brain surgeon, the English surgeon, uh, and remarks and of that Harry Marsh. Andi goes to work in Ukraine and volunteers out there is a brain surgeon in a rural part of the Ukraine where their healthcare is completely in comparable to the UK is we'll see myself in a pencil. 20 people in this, while lucky were in the UK with the NHS, which is actually a brilliant health service. A big fan of the NHS rule Ukraine. They don't really have the same resources available. So it's really interesting thing to watch if you want to see sort of comparable health services on something very you know, the NHS very modern, very state of the art, something bit more sort of rural and hazard and Stephanie a very good film to watch this next one I'm gonna talk about. I can't pronounce very well direct you to license, basically, is the region symbol. The medicine in a lot of places is this rod with a single snake wrapped around it, not to snakes. Two snakes is the rod of someone else, and that's a fertility symbol, I believe, but one snake symbol for medicine on get quality able to get that the way around. It's called the Rocks rock of Escape us scale PS again, my pronunciation of Latin, this port. But this is the symbol of medicine, and this is the condition where originated. I didn't put any gory pictures in this, but it's not particularly nice condition, so be warned of that one. Simply put, it also knows guinea worm disease, which I will call it because it's much easier to pronounce. It's a prosthetic infection in which a warm ends up in the muscle. Most commonly, it's in the lower leg. It can also happen in arms, since really nasty photos out there that's happening in the face, and things of that is pretty gross. Simply put, a human ingests la vie of the guinea worm. Sounds like it's gonna take off. I'm gonna lift it up slightly so the fan has more air yet, so the guinea worm gets in Virus La Vie, getting into the human digestive system. Once there, it catches, it grows, and it migrates to somewhere where it's in contact with the surface of the skin in order that it can stick a small part of itself out of you on. Then release further LA vie into water. Whenever you're in water and white prefers of the lower legs, it's pretty gross to look at. It's a worm hanging out someone's leg. It is not very nice, but the treatment for it and why it led to this development of this or snake wrapped around a stick. Uh, is one of these really old medical procedures in which the worm itself would be attached to a stick, which would then be slowly turned very, very slowly over a very long period of time on eventually it would pull that. Pull the parasites out from the flesh, and you can disrupt. Discard. It has been the stick or burn the stick. This is what led to this symbol. It's a worm wrapped around a stick. It's not snake and a cane that less than sort of more funky modern version of it. But it was a reduced, a worm stuck to a stick. Kind of disappointing when you think about it on. Because this is one of the first known procedures carried out by traditional style medicine men, it's salt. That's where it sort of developed from. It's not particularly pleasant to look at. Their still carries out is the step to this day. Guinea worm is still a problem on gets know, very nice one to come across. Thankfully, we don't come across it very much in Europe, much more common in countries with no proper sanitation, gin and tonic. Sojo tonic. I put in here because it's just my wife being British. It's what my favorite, um, old medical treatments. And it's one that I think most people probably come across today, Um, some people during the days of the British Empire, malaria became quite big problem with. The people from the UK have never come into contact at this time. Hadn't really come into contact mosquitoes on places where they were now serving within the military. Well, quite prone to mosquitoes quite prone to malaria. Um, so they had quite a lot of soldiers going off ill on. That made quite problem. You kind of your soldiers doing their job. You double them lying in bed with chills. Um, at the time, the only real treatment was the think of Jesuits. Bark or quitting. It grows in the East. Indians. The Dutch with the people who discovered it, discovered it worked, and it led to them having a very successful trade route with most of the Tropic tropical countries because they're sailors weren't getting a six. Everyone else's, um, cynical note. Queenan tastes awful. It's incredibly better, almost undrinkable. Um, and what? The way you had to take it was that had to be infused with water, and you drink it. This between us tonic water. So the tonic element of the June a tonic tonic just really just It's a secure A treatment or ah South. And so it was cured water. But from was that no one particularly wanted to drink it because it tasted really terrible. So therefore that came up the idea that if you mix it with gin gin the time being probably the cheapest alcoholic you get hold off. In the UK, it came from a lot of different things. Quite sheep. Um, yeah, this invented the gin and tonic. So people, the gym would cover up the taste of the tonic on encourage soldiers to go and drink it. Therefore, helping combat malaria went serving abroad, and also this is still a thing. Today. It's still quite a big part of our culture. Think most nations now does drink gin and tonic. Not really sure of the drinking abbots in most countries, but it's still quite popular. Beverage, certainly where I am, this is the last of the conditions I'm gonna go through purely because again, it's an interesting one that we still use to this day on. That is the leeches I think most people have through some sort of the media sort of television would have come across the fact that during the medieval times leeches were quite popular treatment on back early. We still use them to this day. Uh, sorry for the low resolution of the image. I don't know why. It's so really resolution. The basically in the medieval era and before there was this belief that anything wrong with the human body has to do with the four humans on these were relating to the four classical a moment, sir. Three wind fire and water on. If these things were out of balance in anyway, you got sick. It is one of the very early beliefs around how people got unwell. Talk more about some of the later police. In a minute, I said, we put these around balance, you go on well, but leeches became this sort of classical cure idea that they removed blood or they cleaned the blood, removing some of these elements to help put it all back into balance. That and therefore making you less sick. Similarly, things like bloodletting were quite common. You literally cut someone, let them bleed in order that things would fall back into balance. Um, the evidence behind it, I think, is pretty poor. To be honest, the he's a nice doctor. I'm again with some of the more old fashioned ways of describing for humans. Yeah, simply The leeches were meant to try and put people back into balance. Other things. The long side leeches were also offered things like eating different herbs. These were meant to sort of balance out these humans again. But nowadays we know that this was pretty wrong. Some people still seem to believe in the balancing of humors. I don't really understand why boys, all these beaches, although for just different reasons here, a leeches on until June chest. Maybe not sure which part of body that is entirely, um, we've heard a medical issue which literally is medical leech. They're specifically bread for this purpose of the nicely sterile captain. In very safe containers, there are less like to get infections from them, which is a problem with anything that's trying to eat you. They are normally used to improve blood flow in areas of dead tissues. So basically, if you've had a skin flap replaced because it's cut off throwing plastic surgery and things like this, they're quite good at just sort of sucking out stagnant blood and allowing new blood flow to go back into the area. That's that's actually quite popular. Still, for among certain plastic surgeons, I don't know how commonly they used of certainly syndrome before in the hospital, in their container of tennis in the morning, the patient, but in the and then I sort of big glass containers where they kept before there used, but yeah, so that's leeches. And they're still continued modern use. They're actually quite cute. When you look at them from a certain angle, that might just be me. Um, yeah. So that is the end of the element of, uh, different medical conditions. Talk a bit more now about the actual origins of health care. So has ah, said health care comes back of her long way as long as they have been people. We've been getting sick. Uh, we got evidence of planning for about 7000 years ago. Evidence before that, even of dentistry interventions, people were removing rotten teeth. Amputations. We've also had things that herbs and acceptable medications involved Really. Health care in the UK became more formalized when religion became quite bigger thing, uh, during the ears before Christianity. We had things like druids, another source of healers. As Christianity came across to the UK, monks, nuns, Onda, religion and healthcare, particularly in Europe, were very tight together for a very, very long period of time. Largely it was it was monk lead. They were sort of the physicians on nuns were very much so. Nurses, um does this belief that God chose who was sick on only really food with a religion and the help of God, could you get better that monks and nuns didn't really do a lot? The minute they were allowed to know about medicine was was very limited. They're sort of ties between religion, Satanism, no religion, citizen healthcare, Satanism on. Basically a lot of what you did was you looked after the sick until they ever got better. All they died on, then you gave them a nice burial. Um, that was a lot of health care for a very long time, particularly in Europe, Uh, and ultimately only really began to get better in what's known as the medical Renee salts under monastic healthcare. Uh, really, You didn't get very much you want allowed to study sick people. It was only really insult of the notes century that there was a beginning of development in that area. Monks relapse. We talked medicine role in making it up. They went along, but again, it was still pretty basic things like that section, which is for a long time. It's been a key part of medical teaching. Learning how the body works wasn't allowed. You weren't allowed to desecrate the dead complicated surgeries. Therefore, we're out because you had no ability to learn what you were going to do, so you couldn't really do them. Talking about being unwell wasn't allowed on really anything to do with being a woman like treating women anything to do with their femininity wasn't really allowed. Monks weren't allowed to go near the near that, um, and this sort of taboo nature, you know, allowed to treat certain people you know, a lot to learn. Certain things really helped medicine back for a very, very long time. And it wasn't until the 14th century 13th, 36 that women were actually allowed to have any sort of treatment, really from the religious medical bodies. Uh, even then they weren't really keen on getting involved physically. Things like childbirth. Um, and it is quite unpleasant part of history, really, in terms of medicine that it wasn't allowed to happen. This is going into now some of the theories behind how people got sick, the first one that really brought us forward from the old idea of just It was an imbalance of humors, or it was a decision made by God. It was the idea of spontaneous generation. There's actually a rest for a book I'm still trying to get my hands on, which tells how things came into being and spaces idea that certain things would interact in certain ways, and that created what you didn't want. So the idea that mice could be produced by letting hey go moldy in a completely dark room, or that if you allow meat to rot in the open air, maggots will develop. No one's sort of went on the idea that maybe the mice got into the hay or the maggots got into the meat. They just assumed that certain things would interact in certain ways. And there you go. Now you've got whatever it is you didn't really want, some that developed a bit during what's called the Met. What? Well, during the run a sense, the medical Renee, since I refer to as during the regular in a since 16 to 18 centuries that 15 hundreds fruits, 17 hundreds. Um, and this is when sort of scholarship became quite priority in the Christian world. But actually, even then there was still a lot of sort of being held back by by religious president. Um during this period, we finally saw some of the Greek, Egyptian and Roman scientists being translated so that people could read them and learn from them on. Actually, what is probably the main deck this area was actually accepting the work done by Islamic scientists from from some of the Middle East and Far East areas. Um, because before, if it wasn't written by a Christian, it didn't count. And now, suddenly, people from other religions being accepted on that became really useful, because actually, there wasn't quite the same level of taboo. No, you can't study that within certain other religions, and that something brought forward European medicine a very long way. Now, medicine was science. It wasn't just religion. Uh, and after a period after a while in this period, people were beginning to investigate, people began to learn and people began to teach, which is really important elements of medicine. Um, here's some of the really important people from that area that you wanted to mention The salads discovered on began to describe the anatomy. The human brain began taking apart and seeing what was what we began seeing medicines being developed services. Who I believe, is this chap at the top, the one who looks like a villain from the Three Musketeers. He figured out how the lungs worked, and he figured out how blood work within the lungs. William Harvey, who's the chapel? The bottom figured out how the circulatory system works where all the blood flow went on. Figure out how blood moved on an anti van Lew hook, which is probably a complete butchering of the name Anyone who's Dutch. Please feel free to send me a message about how you probably pronounce that develop the microscope. And this led the discovery of bacteria now beginning to understand where infection actually came from, and that is a massive, massive changes. I'm sure money, if you can imagine in how we treat things, is now we know what we're trying to fight. So, yeah, the the sort of Renee since hear of scientists, doctors, maybe even you might call them, um well, massive. They completely changed the game. Other ones who really important. Jenna Edward. Jenna. Very. He developed the first small pox vaccine a bit later than the Renee since the later end of the run. A sense, but he's really important to mention. It's always worth remembering. Jenna. He actually copied a Turkish idea, so he didn't come up with it. He copied reading. Could be some readings he done from one of the Islamic scientists from Turkey. And he took a sample of puss from someone who had cowpox and rubbed into a gardener. Son, you then about it. And that's really why I remember General, particularly he was the first one to publicize how this worked on proved that it did work, whereas price of that people have developed the treatment. But it was sort of passed down that sort of hearsay. I you know, this is what I did. You do it. Two seems to work brilliant. But he was the first one sort of put science behind it. Lupus store enough one of it. Later on again. Pastor developed germ theory and he came up with the idea of how microbes could get into the body. The idea that the air was full of them. He did this for everything with boiled swan flask, which was a flask, ovary covered neck. It makes it even know where I get back for it. The broth in the brook last remain clean and fresh. But as soon as you spoke the neck of this one on the lower air in, it'll went molding and gross. This got rid of the idea of spontaneous generation. It proved that infection was traveling and how it was traveling on this tight and nicely with with vanloh unhooks discovery off microbes, we now knew they were there. And we now know how they kind of worked. And pastor is where we get the word pasteurized things like milk removing of bacteria. Um, Joseph Lister, from where we get the word list urin which think that the next time you're cleaning your teeth and you're using the stream mouthwash, um, he followed the work faster on. He came up with the idea of cleaning, which is quite a weird thing to think these days, but actually, this man basically invented washing your hands. He's dilute carbolic acid, which is a cold based liquid used to clean hands, equipment, all the stuff that's coming to contact with the patient on. Actually, following about a year of doing this, he he was able to publish saying that actually, few of his patients now dying, which is amazing. He's the guy who basically approved washing your hands didn't kill people. It also lead to a lot of the people he worked getting really nasty skin on their hands because female cop, it's like acid that it carbolic acid. It it really doesn't do nice things to your skin. So whoever invented moisturizing, I think, is also have ever hear of, I can figure out who they were. Um, all these developments. Scientists and people becoming medically trained wanted to go and see sick people in order to continue to study sick people. You needed access to sick people. Generally, they were like doctor by the church away. We looked after in very early hospitals, some Bart's in East London, symbol for you, and these were sort of very full of sick people just being cared for her until they got better. They died, Unfortunately for the latter than former, Um, what's this? Began this idea of an educated physician, people learning and studying sick people and then going on to treat thumb on this idea of learning to be a physician rather than just deciding you're going to be one hum. Generally, they were the first doctors who actually touch their patients prior to them. You still stand at the end of the bed, listen to what the patient had to say and then assume you knew what was going on. Now we had assessing patients. We began actually asking them questions and sort of trying to figure out things on recording it a lot. A lot of the people working in these hospitals at this time we're trying to discover a disease that make them famous. Um, and this is where actually we began learning far more medicine on teaching it. This was the lead to the development of the first medical schools. So in England's and Buffalo, um, using these London and guys, which is the picture behind, is a drawing of guys hospital, which is in so self basis right in the middle of south London, isn't it's, It's not east or west in France, really are Salamanca in Spain and Bologna in Italy. And these were sort of the very first medical schools the teaching of young doctors, young physicians They were at this time, uh, in order that they would be better when they actually went and looked at sick people. Likewise, the birth of the surgeon actually the surgeon on the physician was separate it this time. Obviously now they're all doctors that actually originally they weren't Surgeons have always existed. Anyone was sharp rock, concave it a good go. Probably not do a very good job of it, actually, but they give it a go. Many of the early developments were Arabic. They came from the Islamic scientists. It's really important to reference that because actually, I think a lot of the History Island particular when I was younger in the UK, sort of ignored people who weren't European. But there was so much of the discovery, and so much of the research was actually done by Islamic scientists were abroad. It was only really in the renaissance that we began listening to what they said and what they discovered. Um, proud of this. We had the barber surgeon. The barber surgeon is quality. That he was a barber and a surgeon. He was a hairdresser who also cut you open so you could go into a local hairdresser and have your mole removed. Your broken leg reset the cuts on the back of your head stitched up, and then your hair cut and your faith shaved all about the same guy sort of in a package deal, I suppose. The idea of the barber pole? Actually, it's lovely. Candy strike Barber pole we have over here. It's thought to have been a blood soaked drag that was held that was sort of wrapped outside. I'm waiting to dry exactly back then you didn't wash your tools. That be silly. You just use the same blood. So, Greg, from this morning that used this afternoon, you just have to let dry off a bit First, Um, that's that's how you early in the early days, identified by the surgeons and where they were working, it was because they would be a blood soaked drag hanging up outside, waiting to dry off, which led to the lovely candy striper Barber Pole. I don't really know what led to the barbershop quartet, but I'm sure that came in sometime of it. Later, the apothecary, the third sort of branch of what became the doctor, is the apothecary. They're actually the original pharmacist. They made lotions, tonics, medicines, whatever, Uh, in also treat a laments and sickness. Much like one pharmacist. They work in different areas. However, that work in the early hospitals that could work in the community. But the big difference between them in the modern pharmacist is they weren't really taught anything. They learned through listening to a previous apothecary or they just made it up. They made concoctions. However they wanted it and would sell them for whatever reason. Um, so they were very reliable. Some of their work was good, but obviously you can imagine if you're making it up, is you go along, you know, all of it. Waas. Eventually, these were sort of merged in with the early physician to become the doctor. Surgeons joined a bit later, which is why lot surgeons still use Mister instead of Mr or Mrs rather than doctor as their title. Because actually originally doctor was separate from from surgeon. It sort of a traditional thing now, um, but for about 200 years, pharmacists as they are now apothecaries they were, Then we'll train in the same way as doctors. And then we go off and do what they want to do. That golden Make minutes and Billy had to be the same as the doctors originally. Uh, however, now bit later on down the line. And as is the case now, they sort of branched off again and that we have pharmacists who are very, very useful and again do a similar thing. They make the medicines or they sort of know the most about the medicines to stop Doctor's doing silly things. Um, the nest. The mess is a really interesting origin. Really. Uh, originally, the word nurse comes from, uh, a word I won't even try pronounce because my Latin is terrible. But the word to suckle on this meant towards wet nurses. A wet nurses, basically someone who are rich person would hire to feed their baby for them. So they didn't have to, um and their job is to feed. Yeah. See what wealthy kids, um, later on it began to develop off the early on. You have nuns. Nuns would care for the sick. Later on, we began to develop the professional nurse and the idea of nursing went from feeding babies to sort of caring 30 of the sick. Um, as it develops, the church sort of began to let go of looking after all the sick instead, and it became the job of them. Or the more professional nurse Florence Nightingale has to be mentioned. She is such a important part in the development of the water nurse. Um, she basically changed how nurses were. They went from grand, um, human beings off the street who just were happy looking after sick people to people who've been trained. She was having the Crimean War, which was a walk in the British and the Russians place Crimea. Uh, and she really didn't like the fact that just basically wounded people were allowed to just lie on the floor, get sick and die, because that was the quality of care of the time. And she sort of developed this idea of nursing lead care in which your nurses would wash people that have changed the beds they would look after the medical supplies, they would change wound dressings. They would give out medication. A lot of stuff that just happens these days. Now that nurse is a Rabel to do, sort of championed originally by Florence Nightingale on made to be the case and basically the idea that looking off the patient Data Day was now the nurses job was previously the doctor would be the man who would still go in. He dual the You know, the wound dressings you do all the medications, give every medicine, every patient on dinner. So just sort of, I guess, do is, they were told, and just do this sort of hand holding and feeding elements. But now some of the nurses were important. Andrea Lee important on actually a letter massive improvements in the amount of patients who survived being wounded in battle and survived the infections they received thereafter. When nothing okay back to the UK after the war, she actually formed the world's first nursing school, the Nightingale School of Nursing, which is in Waterloo, in London, on it's attached to King's college. So a massive, massive a part of the development of the mountain that's really shouldn't be understated. What? She actually did the ambulance. This is one. Actually, I put in here because no one knows the guy who invented the ambulance. I think a lot people know a bit about during the night. And girl, no one knows about Dominique July, who I think is probably my favorite century French session. It's weird that I have a list. It was a French military surgeon during the French Republic under the polio he's famed. Basically, this guy completely changed the game with emergency medicine. He really trying to the game with medicine will stop. The most important thing invented really was the flying ambulances they called it. It was an ambulance was called the Flying Ambulance because it moves very, very quickly. Um, this was he sort of went in stools and canons off of another element of the French military on because they were removed so quickly across the battlefield. He said, right, I'm going to get a cannon off of you. Put a cart on you, and you're gonna go fetch my wounded men for me on the also then trained them in the original first aid. So he invented the first aid. Uh, he invented the ambulance. He then also went on to develop things like the tourniquet, which is a tight strapped. You put around a bleeding limb in order to reduce bleeding, which dramatically changed treatment to get in the emergency world. He invented that for treatment center. So rather than taking the patient all the way back to a hospital, you now had a treatment post where you take them for being patched up. Before then, Fareed on later to the hospital on he was invented Triage, which I think is just in my head is ridiculous. The fact it didn't exist before hand before lower a you were treated based on how important you were. So So if you're a king with a cut finger, you'd be treated before the regular man with a missing foot. You know, it didn't matter how severe your injury waas it was how important you determined how quickly you were treated. And he came up with this idea of, Well, that's completely stupid. Said right. So we're going to treat people based purely on how badly there hurts and not on how important there. So suddenly some really a lot of people get really upset with us to be honest, because suddenly, if you're really important, you want to be treated first still. But you're being told you couldn't be. And he actually also included in that prisoners of war. So so enemy soldiers who were wounded would be treated according to how severely that hurt rather than just the fact that they're the enemy's there left, um on, like where Civilians who injured in combat. Yeah, The man really did change the game when it came to medicine, and he was just really interesting as well. The the the tops of the portrait of them. But the middle picture here is a part of him removing the colonel's arm during a battle and apparently during the battle, one of the attendance one of the men helping him with the operation was shot and killed while she was still cutting This man's normal. So impressive there on the bottom is him actually treating someone whilst they treat the third person. So one of the other doctors was injured. He treated that doctor whilst that doctor then treated someone else wounded. All of which makes him quite cool, in my opinion, was the man who invented the ambulance event. It basically invented the first aid or a swell and then raise the lead to the development of the paramedic. And he invented triage. You went to the tourniquet. Incredible. Very much worth remembering. Um, that's delay. Mental health care. Definitely the mentioned the two men at the top here, Freud, Andi Young. I think everyone probably send anyone working and help mental health. Probably have heard of both of them. Between them, they still develop the idea of talking therapy. The idea of talking about being unwell, on getting the support you need a mental health problems, both of them, actually, based on what their work on the work of the chapel, the bottom is probably more of a favorite 18th century French surgeon was your martini Charcot Charcot's again, is what his men has completely revolutionized. Healthcare, which I think gets under overlooked a lot. Um, Charcot did so much do with nerve damage. He's got about three or four different conditions named after him, most of them to do with the feet on nervous damage of the feet. But he also was the one who decide who came up with the idea that the brain and the body might influence one another, and that you're things that impact on your life might impact your mental state and therefore influence your body, and vice versa. He was little bit off. He thought that involved physical damage only. So, you know, if you underwent trauma, he thought that was changing the physical matter of your brain rather than just in your mental health. Um, but, you know, massive, massive developments in the world of mental health care. Certainly thanks to Charcot. And that then led to the work of a Freud and young. All of them really important people in terms of mental health care. Very useful. Um, yes. That's also going to mention about it in a car, but it waas um yeah, traditional medicine. So this is now coming forward to the Morton Day. This is still remains this idea of traditional medicine. So this is the idea of medicine predates modern medicine, Modern medical sciences, most traditional medicine. Most old medicines that were has been adopted now into the modern care. I'm normally following some sort of specific refinements, so this could be things like herbal medicine. This could be things like acupuncture. Things like cutting. Um, all of these, it's all tied and believed to be a part of other cultures. Medicine, Chinese, traditional medicine, Indian traditional medicine. They're actually a lot of these in our part of regular medicine. Um, the bits that are left out and aren't accepted are normal. Normal is alternative medicine. So these are the ones where there's no evidence supporting they work. Um, and it also includes quite lot disproven theories. I thought this was just worth clarifying because actually, we talked about history of medicine on basically history medicine. Traditional medicine branches into those two avenues. One of them is now modern on one of them is alternative. Um, that's another made very clear or not, but yeah, the very worth mentioning at this point. This, I think, is my last bit of information for you. And then I'll check on any questions of central talk bit more about how the rest of Syria is gonna work. Um, this chapter is night. Bevin know Bevin was a Welshman on he is the man credited with developing the NHS. Um, off the second World War. The UK was pretty halid. We've had a lot of damage down the war. Well, I'm sure you can imagine what the war did to the country. Um and there's a demand that the people of the UK wanted to be looked after better having gone through such hardship, Uh, the existing conservative government went out. In came a labor government on this chap night, Bevan was appointed to be the minister of health. Um, his where he lived in Wales. There was a local charity that gave three healthcare to those who couldn't afford it, regardless of what was going on. So you basically would support you financially to look after you. And he said it took this model and went well, why is that? Only in this particular bit of whales, his four. To be one of best economists ever because the NHS was incredibly expensive to make work and he did a huge amount of work to make it financially viable on get the NHS off the ground and make the NHS Originally it planned. Yeah. Originally, that been the plan everything you needed health wise would be covered by the NHS. Things like glasses, things like dental care. General, I care all the medication that you take will be paid for by the NHS on. Basically, they ran through their entire five year budget in about five months. They spent far more money than expected. Largely could. I think a lot of people in the UK had never been able to get hold of any medical care in the past. And so we're catching up with all the care they've missed out on getting glasses. For those who never had glasses getting the teeth fixed, there's a number of the teeth fixed cetera, um, and they had to make some gentle adjustments. There are some things under the NHS you still have to pay for, like, glasses or general I care. Dental care is partly subsidized. There's normally a A set Pfieffer. Any chest patients and anything beyond that with in that bracket is will be covered under any chest prescription feet. So you pay passes the cost of the medication you get given, Um, and this is all to help make the any chest more financially viable. This is all stuff, I think just from recovering in a minute, because his session is more on the NHS. But I thought this is a good way to just tight Teo George's session. I'm gonna stop talking for a minute here and has been everything in the question in the queue. And I don't think so. Yes, you've got a few questions. Um, Teo, uh, questions for you. Things like, Why is it happening used today short. Go back. Sorry for the, like. Headache of this flex back to trip area. Ah, so why we're using planning today? If you watch the English surgeon, I think he goes through a lot more brain surgery than I have a plan to, but simply put, largely, it's do a pressure. So in things like certain traumas, So if you get back on the head and get bleeding under the skull and that I think is the most common time you would use it, you drill a hole in the skull to relieve pressure so the brain isn't completely squished by the pressure of blood. Um, is that the only time we use it in the modern day? That's the only time I can think of where it's been. I've come across it being used modern day. Obviously, we still drill holes in the head anytime We need to access anything under the skull, Um, but yet that mainly I think it's in case of trauma. Sometimes I think in the case of certain infections as well. But it's basically when there's too much pressure under the skull. I heard that. Also is that question. Uh, anything else? Question to? Does religion still impact the development of medicine today? Oh, that's a good question. I think the answer really made in mainstream medicine. No, I think it doesn't really. There is also a lot of ethics we have to take into account any sort of medical developments on your procedures, and you medications have to be to go through a lot of ethical approval on. I think maybe some of the earlier side of ethics was involved with sort of religion based by think they've developed beyond that now. So in terms of mainstream medicine note. But outside of the NHS, outside of mainstream healthcare, I think there is still elements of religion influencing healthcare, not so much in influencing the development, but I think the application off. So there's ah, remember for a while using very apparent example, use the the coated vaccines. I remember There was a lot of really on those people claiming that it it was unsuitable to get coated. Vaccine, if you were, is that if you're a Muslim or if you're Jewish and claiming that there were problems with the vaccine that made them Haram or non kosher? Um, and honestly, that letter, that nonsense and the various authorities of those religions came out was saying, No getting vaccine, It's fine. Um, that's quite good example, I think is certain, not necessarily the whole religion, that certain groups of in religions don't like certain elements of medicine and certainly anything that involves sort of flesh, I think their flesh and blood. I think certain groups get very unhappy with another good example with the jobs witness where there, then not all Jehovah's Witness will accept blood products. So blood transfusion. Um, but that's more and to do with particular procedures and particular elements rather than development of of new medication. But if that answers the question, I hope, yeah, I'm gonna move off this sculptor, he's looking at me. Next question is, are things from the session things we can use? The personal statement. It has a thing for personal statement. I don't know how directly applied. Obviously saying you know, you attended the sessions shows interest in interesting development in terms of health care. Um Mawr also just giving you just general background in medicine. Really? It's that sort of making you more rounded candidates, I think. Yeah, I don't have that really answers again on then. If from the kind of nursing origins nurses tend to be female when stroke, why did the introduction of male nurse is begin? What's a beautiful question and I really don't tell you the answer. Um, let me think from I know certainly after the Second World War you still have the separation of nursing rolls you had orderly, which tended to be men on nurses, which were women on orderly sort of did all the very physical element of nursing and nurses. Did the nursing element of nursing so orderly to do things like rolling patients moving them around, doing a lot of heavy lifting on, They tended to be sort of more involved in combat side of things on nurses tend to be more in the hospital side of things and orderly sort of became who were on ambulances in the end, and they were doing more of the sort of pre hospital side of things. And that's what eventually lead off with the paramedics. When did they combine? I don't know. Off the top of my head, I know purely going off. My experience with some John ambulance I know sometime around the seventies was when we began having combining two units. So before that, you'd have women's only units nursing units. And you have men's only units, which were ambulance units. And it's sometime in the mid to late seventies. He began getting combined units, so I would imagine it's somewhere in that in the sixties and seventies, I'd imagine you start getting male. Nurse is on obviously similar time. You start getting female ambulance technicians, paramedics, whatever they were called the time. Um, now it also correlate quite well with when you start seeing a lot more female doctors. So I probably imagine it's all the sixties. So the mid to late sixties early seventies was when you get historic gender roles in healthcare, start to sort of blend. Um, yeah, I think I think that would be the best I can come up with that going on and in quite a lot of reading. But I think probably then I think that's all the questions. There's one on privatization, but I cover that kind of in my session so we can get it later. If you want to know where you see that one also is not really an answer, is it for them? But I was going to ask, cause they don't know what this creature is. You know it's creature. Is Josh No tickly? No. So this is no pangolin. I love little pangolins those you have never been to a session I've ever run before. I always like to finish with some sort of cute little animal just because sometimes we call this heavy topics or whatever, and I feel it's a nice way to finish pangolins on their ability to tie back into medicine is more sad. One really anything else. So pangolins here became quite badly endangered because of a belief that they have medicinal properties. They used in certain elements of Chinese traditional medicine, alongside things like shark thins and all sorts of other weird and wonderful creatures being chopped up. Sadly, But these are one of the poor little things that gets eaten as part of transitional medicine. Um, I can't entirely remember what they used to treat, but I think it was something to do with impotence and sterility, and they see lots of fertility problems. Um, but look at that poor little thing during a Really? That's try and make you feel better. I think I've been worse. Poor little thing. The factory. They're starting to increase in numbers again in the wilds. That's the sort of positive spin on it for the poor little pangolin. They're starting to get more of them now that they're protected. Um, they're all really adorable and really, sadly like if humans go near them less and they tend to be a little curious creatures and come right up to you looking for you. So they're quite easy to snag in the wild. Um, just kind of sad. Yeah, that's a pangolin. Um, so, yeah, that is the end of my teaching element of finished five minutes earlier than I intended to. Just impressive. So worried is going overrun. Like any questions. Feel free to put them in the chat. Also feel for it. Email me them. Otherwise we'll have a bit of a break and I'll get just to start. Maybe maybe I'll get just to start slowly earlier than intended if we have about five minute break now. Pretty good. Just a couple of other questions you've got. Um, so about a pangolin scale supposed to be useful in medical applications? I don't know. You know what? I know the flesh. I think you're gonna eat them. But I don't know about the scales. I have to go. I don't really want to look up toe, have to eat pangolin. But you might be right. They're also sometimes get a little blurry and they look really cute. But yeah, we've also got one wondering when mental health became assume apart, worse off medically, uh, research thing. It said person asking says they got it to be any chest in 1959. There are some, but it became thing. Oh, yeah, I know a very good question. So obviously varying levels over time, The first sort of major cry out that they want for mental health care came sort of around the first World War when we're starting a lot of patients with what's called shellshock, which is basically PTSD a time. Shellshock was considered cowardice before we got classified as mental health. A lot of people actually mentally ill or being executed for being cowards, which is pretty bleak. Um, that was in certain European countries. That was common, right up until the Second World War actually passed the second World War. Um, it was quite quite sad time really again, if you're mentally unwell, people being shocked because of it, yes, that that was the earliest will cry out for mental health care. Freud and Young. I think we're working in sort of the earlier parts of the 19 hundreds. Um, Charcot himself was in sort of middle of the 18th at the 18 hundreds. Um, something 18. I think it died 18. 60. But that's off the top of my head. Um, so they Yeah, the late 18 hundreds. The early 19 hundreds is when these sort of guys were they were working, um, and developing this idea that actually mental health existed on it wasn't just, you know, people being afraid, people being cowardly off the first World War, I think, was when people began being Mauris emptive to the idea that mental health problems existed. Um, I said, I think added to their chest is care in some of the fifties. I think that probably would coincide quite well with how long the salt things tend to take to develop. Um, and actually, even then, the NHS is covered for implementing healthcare has been shocking for for so, so long. Um, I don't think it was funded until properly funded it all until you say, like in the noughties in 2000, something was when they started, like individually, financing mental health care rather than it being lumped in with all the other sort of generic elements of health care. And even now the funding behind it is really poor. I know the current British government put a lot of I don't recall that money or mantle, because actually it doesn't correlate to the need. But they they began trying to close the gap between what is being spent on it and what should be spent on it on. There's a lot of effort in in place. Try and close that gap, but the gap is massive. It's not been looked at, probably for so long that it's going to take a very long time to catch up and close that gap properly. I don't have that fully answer. The question of just gives a lot more problems around it. Um, yeah. So ultimate mental health care. I think it is a big big that is still developing. Really, Things are getting better. In terms of that, there is more resources being thrown at the problem, and our understanding of it is to improving. When you think of it is saying, you know, it wasn't until two of the 18 fifties under shark er that this was even realized to be a problem to be a thing, you know, Shock oats or the first person who decided that mind and body were involved with one another and that, you know, traumatic experiences like emotionally traumatic experiences could shape physical symptoms and could cause you to be up, you know, unwell. Um, you know, it's only 100 50 years ago, really 170 years ago, so that, um it is very recent as a development in compare it at, you know, surgeons and all them and going on for 6, 7000 years. Um, yeah, it's quite a I think that still is a long way to go to mental health care, but it's come a lot faster than a lot of the other sore things have. And then if that answers questions or just raises them, but yeah, anymore, Melanie, I think that's it. I think we've got a couple we need to just answer in the chapel. I think that's all the questions for you. Weigh. Go for a five minute break so people can just stretch their legs refreshed refugees and things like this on Do that. Let's call it half past Josh can kick off with, uh, yeah, just can't take off with his session. Right. Good. Children on. Someone asked me to put the timetable up. So just on that now and someone would be to put a timetable up. So just on that now, before I start, you cannot have a look. It kind of the sessions that coming up? Yeah. We'll start at roughly how fast. Thank you. Okay, that's just hit, um, half past. So I think we'll make stop. Um, yeah. So I left the timetable 15 minutes after. Look, someone asked if we could up the green timetable. I don't have the wrist. One that might be Freddie of liquor. Um, but yeah. So, uh, my name's Josh. I am, uh, finally a medical student. Imperial. So I'm almost a doctor, but not quite. I thought I'd go over kind of the structure of the NHS because it's something really important to know about when you're thinking about Korean healthcare on D on. It's something they could definitely kind of bring up in interviews. This is also helpful for personal statements, but it's definitely something that bring up on interviews. Just kind of check to see what you know about the address, and hopefully this will kind of cover a lot of what you need to know. So, in terms off what we'll talk about, um, so, uh, well, isn't you go through the creation of the I just thie hs on its struggles. Kind of where we are today with the NHS. So before 1948 um, it basically it was very, very expensive on infection yet so yeah, before 1911, So healthcare was basically entirely private. It's kind of frightening that mentioned everyone had to pay out of pocket on. It was really, really expensive to the point where basically no one could. Uh, yeah, let me know. No one can afford it Basically, on infections such as TB, diphtheria, and that we're kind of running wild on. There was massive infant mortality on, but there's also a massive healthcare luxury. So if you lived in London, you actually quite lucky because you had a giant kind of access to all of the hospitals with all of the best doctors. But if you lived in the countryside, your options for healthcare were to travel a long way or to go and see one doctor and cottage with maybe a bad Um and that was about, um so in 1911, they decided we should probably change the way the healthcare system worked on. But they created the National Insurance Act, which allowed workers to contribute towards healthcare from their wages in exchange for free healthcare, basically. But the problem with that is that it only actually covered the workers themselves. And at these times, women didn't really work. They were kind of more housewives on. So actually, this act only really covered the men. Unfortunately, so actually, women and Children would have left out from that. I understand, uh, in 1920. They can floated some ideas for the first kind of national health service on They wanted a taxation based else service. So everyone paid a little bit tax towards the Xs on. Then it would have been free at the point of service. And this is brought up by David Lloyd. George is government who was helped leader through World War. Um, but actually, the government then got voted out on the plants completely abandoned on know whenever I start them, Um, so then in the 19 thirties. But it can be kept on this enough insurance in the system, and it's partly private as well. But the cost comes. Sky rocketed on back in 1930. Apparently, they cost for a doctor visit was about three shillings in a six months, which I don't know what that really works out to try to work it out, but I couldn't figure out. But apparently it's essentially, it would be difficult for even a middle class family to afford a visit to go see their GP equivalent. So be very, very expensive on. Only really the rich could afford it. So between lucky 34 90 38 they again decided that actually, health insurance should be extended. Teo the dependence of the workers. So it's a few women and Children and that they thought it would be a good idea to merge all of the different systems we had together. Some used to have charity systems Andi government run hospitals and hospital from other people. But in this case, we on they thought, You know what? We should probably merge those together, that that natural have happened because of what you happened. On other things. There's kind of a bit of higher priorities eso your mobile to They actually then formed an emergency hospital service, which allowed free treatment, but only to those injured by enemy action. Eyes that vague what they meant by that so you could get healthcare anywhere, not just like a local. Still, it's a lot of Children were kind of sent away to the countryside rather than in the cities. They were able to get healthcare. They're if they needed it on. But there are a lot of access free healthcare, and it was the first time really, the that there was a free at the point of service healthcare system that could be accessed by everyone. On kind of a result of this on, they reach a consensus that the two main priorities after World War Two where Postwar recovery, of course, but then also the welfare of the people. So in 1942 90 43 they commissioned, I think of the beverage report which laid out kind of plans on Do How We Will Go fund, um, basically the recovery from World War Two. And it's part of that Waas the idea of a national health service. So in nothing 44 the white papers were published and he's basically set up the founding principles of the NHS eso in 1945 ast, Freddie mentioned the leg a government came to power on Do they floated the idea again of a national health service with all of these things could have in place on then the minister of time and you're in Bevin on 9 11 was given the task kind of injured introducing an HS and these are the principles, so it would so so the and it just was designed to be free at the point of service. It would be financed from the taxation, so everyone would pay a little bit into it on. Everyone would be eligible for the care. And that wasn't just people living in the country who are from Britain. That was people who had come across from other countries is a big influx of immigration after World War Two on, but they wanted to make sure that they were eligible. So what's really interesting is that the idea, then it just actually come come from a small town in south? Well could trigger. It's down there near the rectum beacons on D. It also happens to be hometown of night. Bevin and I have a system where residents would pay a subscription that essentially funded access for one of the towns inhabitants have free access to medical services on, Bevin said. In 1947 all I'm doing is is extending the entire population of Britain benefits we had in trigger for a generation or more, but going to tread arise you, which I thought was quite interesting on. So on the fifth of July 1948 on the chest was formed. Is the birth in a chest on? Everyone was sent one of these letters, which basically said we will provide you with medical bet. It'll a nursing car, everyone rich or poor man, woman or child that can use it. There are no charges except for speech, few special items. There are no insurance qualifications, but it's not a charity you're paying for it. Mainly, it's taxpayers that relieve your money. Worries In times of Bill nous, any chest was formed on it initially had a structure that started with the mint. Minister of Health of the top is kind of the same at the moment on it was a tripartite structure, so it's had three different developments. So our hospitals, um, on day, one thing they did was murder of hospitals they mentioned earlier. They created hospital boards, and they gave doctor salaries. His previously doctors were just paid by whatever the patients are willing to pay them for. That procedure, Um, the also then created a system of family medicine. So you had a system of GPS or family doctors at the time. He then could refer you on for dentist care, optician care or pharmacist or until, like with prescriptions, the pharmacy and you also had community health care and local authority services. So introduces, they introduced school masses, Um, immunizations, Onda, good maternity cap and then funny enough, people actually quite like the idea off the chest. There's a massive demand on about 30 million people have been registered by the day of the creation of the chest, which is most of population. And there's some opposition. They namely some charities which didn't want the government taking over that them. Actually, doctors didn't like the idea of the HS. They felt it took away their independence. The BMA, which is the British Medical Association. So it's essentially the doctors you union in the UK they completely opposed to an agent the idea of being addressed. They really didn't like it on. They actually forced some compromises to the initial plans so that doctors working would kind of get on board. But eventually they did it on board. Then, in 1951 just three years after its creation, they basically realized that healthcare is very expensive on. Dave really struggled to pay for it. What the government drug to pay for it on do it was labeled in the government. This would be the beginning of the end of this new fabulous self service. The times the prescriptions costs. Yet they is. If you brought in some charges for things like prescriptions, dental care, glasses, that kind of thing. So prescription would have been one shilling flat rate, which is about 1 lb 61 today? No. Yeah. Which would be about 1 61 today. And in comparison, then it just charges about 9 lbs, 35 per prescription. Now, on dental treatment again was a 1 lb flat rate, which goes to about 30 lbs. 22 today and the indigestion Arges anywhere from 20 lb 80 to 282 lb. 8. 80 depending on kind of a band of what you get. So it was a lot cheaper than today, but it was still there, still hunting charges on then in 1965 they realize that people don't actually like paying for things. So they removed the charges, but they crept back in in 1960 acres. Again, they realized that if you if you get the government is the only person that the only thing playing for things, it's gonna get quite expensive for them again. Eso They reintroduced prescription charges, but actually they reintroduce them with exemptions so the elderly didn't have to pay for them. The pregnant people didn't. People with long term health conditions reliant on medication didn't have to pay on Children also didn't have to pay. Actually, if you look, that kind of system still exist today on, but your numbers about 90% of all prescriptions are given free of charge. So it's only really a minority that actually pay for them. And then, in the 19 nineties, year of privatization began with Monkey. Thatcher and her government services were made more available to set off on it helped. This did help somewhat because they couldn't remove this postcode luxury that was of services. Um, because the truth is that who formed what we know nose and it just trusts, meaning they would make a lot all of the services of able with it one specific trust, so you could essentially wouldn't have to travel that far to get specific things. So rather than one hospital providing a few little things that you could go to, you could go to a trust which hopefully would provide everything you need it. So then, in 2011, about 20 years later, they introduced the very controversial health and social but care bill, which isn't You revolutionized the and it just it completely changed how it worked. It replaced Bottle called Primary Care Trusts with GP lead clinical commissioning grapes which will go into a little bit on D. It put doctors kind of in charge of some services and move lots of things around. And then, in 2014, the NHS realized that healthcare is still very expensive on. They thought that was gonna be a massive funding gap on Did publish, I think all the energy or five year for you, which is a way of trying to address this massive funding got on. We'll go through that a little bit later. So that was kind of the history of the dress. And what's the chest like today? So this is the top cut. So the top of government, you have this guy, this is the secretary of state for health and Social Car. He's basically the representative for all of the government level and sits in the cabinet. Um, on there they decided to the top level priorities for health and social care on day. Generally overall, the amount of money that the any chest is gonna receive as part of his job. He leaves Thie Department of Health and Social Car, which is kind of helped out by a couple more people. So these are the ministers of state. So you have a healthcare. So you got Edward a guard? This guy who's a minute state health. You've got a 19 degrees. Who's the military state for mental health? Suicide prevention. Patient safety on down. What the hell is the initiative? State for social. Then under them you've got the parliamentary undersecretaries estate. I don't know what the difference is. I just know that ministers of state are slightly better than the others. So you've got Churchill. He does things like health prevention, public health and Primerica. You got James baffle who does innovation. And then you've got a Dean. Zoey. He does. Has convert. Got new role in the deployment, a covert vaccines. But actually, only one of thumb has any training or experience. A tall in healthcare career on That's 19. She was a nurse at one point in her life. The rest of them have various degrees from Oxford in things like history and kind of economics, which clearly are very good for running a healthcare system. So else you're seeing The minister of us leads the Department of Health and Social Cut on. That's there, too, Given oversight off all of the health care in the in the country on it helps delegate the services into lots of different kind of organizations. And it does. This have been too many organizations. You got it just England on any chest improvement. So I'm not cover Scotland and whales, and this gets a little complicated after they devolved up. But I believe that's very similar. So and it just England is kind of the H Q of the dress for England, so they are sort of like commissioning services on planning a lot. Then it just it's work, but they actually give most of that work. Teo Clinical Commission groups, or CCGs. There's about 200 of these in the country on, so what these do is they identify what problems there are in vial it'll area on. They allow they're able to kind of adjust the healthcare services they provide, depending on the problems that kind of they have. So you might think in London we probably don't have that many, for example, like farming injuries. So you're probably not gonna put too much money into the prevention of farming injuries on your morphine into things like infection. Something about TV of right in London. Whereas if you get to Cornwall, there's gonna be quite a few farming injuries because there's a lot of farmers than in London. You they're gonna adjust their way. They fund things like you differently on bacon. Bacon basically choose to fund and cheese, which services they provide on. These could be anything like hospital trust charities, GPS things from local authority ambulances. And also they can bring in the private sector as well, so that any chest improvements role is basically to manage money. Really, they are constantly trying to lower costs and making things more efficient, which can be quite detrimental. So along side the NHS, England and an interest improvement, there's loads of of the services, and they will have really weird names and acronyms and really not great, Logo says. You'll see. So the first one is the Academic Health Science Networks Network, which is a network off 15 local academic health science networks, and you could see on the screen. So that has, um, kind of 15 of these across the country on what they do is they want to connect the chest, the local authority on do the industry. So businesses, factories, whatever to try and figure out what the problems are locally in their area on used the technology and innovation in their area to try and, um, trying improve healthcare in that area on thie network off the networks, um, hours for essentially this innovation to be shared across the UK Um, so all of the patients could benefit, so they what they actually do is they remove any kind of health lottery, healthcare, postcode, luxury. They also have the best flow goes on. They're the most exciting. The rest of them are really, really, really boring, Sire. Next left got Public Health England, which deals with public health matters. Surprise, surprise, for example, of it on their roles was supposed to be things like illness prevention on reducing health inequalities as well as disease control. However, very recently they merged with the NHS truck and trace service to form. I think of the UK for security agency on on what this will do is essentially basically just day disease control. They went to anything else? Um, on They haven't really said where the prevention, uh, like illness prevention and producing health in the qualities bet is going to be sorted out, even though that's part of their five year forward view. So watch that space. Next on the list is the sink. You seem to the care quality commission on what this does is deals with safety more than anything on the quality of care on big around the inspect wrists on the second ones. And they say we expect it to be this, like your catch me the specific way on. Do a lot of time. They fight with HS innovation. Is this you steal time around ago? You don't have enough nurses. I want you to have more nurses higher. More nurses on, then any trace innovation ago. Well, we got to be spending all of our money on nurses. I want you to hire a few nurses, don't hire any masses, so they have a bit of a fight. Um, then we have the image. All right. The Medicines and Health Devices Regulation agency. That kind of does as it says so. They regulate medicines on health devices. So they have a role in basically making sure that the trials that go on to um yeah, the trials that go on anti she used which drugs we use and how we use them. Also, which medical devices we use are Make sure there's, uh yeah, I'm kind of provide an element of kind of quality control there. And they also run a thing called the yellow card scheme, which allows for reporting of adverse incidents when you take kind of have involving medications. Um, interestingly, the medicine side of it is actually paid for entirely by the pharmaceutical companies that it's regulated, which do with that information what you will. Then you have a health watch, which is a charity actually on it's they're designed to use if you promote over the evidence based medicine in a specific area so they stop the seat the CCGs from going You know what? We're gonna, uh, commend troponin for all of our patients. Take your headaches, health walk from turn around to go. You know what? That's no evidence based. So we're not doing it. Um, on there also. Yeah. Best essentially what I do kind of thing for my evidence based medicine in specific areas. Then you've got and it just sex, which now commissions a single and it just digital, which are responsible for the information data and I t systems and then it just basically they're the reason why the and it just still uses window is Windows XP. You've got nice or the nothing's due for health and care excellence, which they basically produce guidelines. So they, uh, police guideline something like clinical practice health avoidance, um, social care services on the youth use off health technologies On day Finally, on this list you got health education, England, who provided international leadership about the education, the training off, people working within the NHS. So there's lots of conizations They're they're all try and work together to kind of divert deliver healthcare in the UK and then in 2014, the chest is basically really struggling to cope on do it predicted that actually, we're gonna have a 30 billion lb funding whole by 2020 so they publish. I think all the any chest five year for would be on this. Is that because the test is about the product of its own creation. So it gave people free healthcare, so they were able to live longer. And as a result, you have more people around with MAWR medical conditions that more complex, that require better management in different ways. But the interest itself is no really changed that much to cope with that. Um so the five year Ford you plan aims to a few things on The main thing wants to do is to prevent illness. So they actually the best achieve this way of providing health care is to not provide it all. So if the entire population was healthy on, they had lots of edging their diet on do they didn't really drink any alcohol on didn't smoke on the exercise? Lots. Actually, we'd really reduce a lot of the things in the country that kill people. Eso we'd have so many fewer heart attacks if you're strokes, fewer problems, kidney. If you have diabetes, if your liver problems and we actually reduce a lot of counselors as well. So if you don't have to treat these things, you really got to spend any money on them. They also want to move towards kind of patient controlled care systems. The patients decide what they want, when they want it, where they want it and what the best care for them would be. Essentially would be things like providing dementia care is at home. You don't have to put people with dementia in a camera home or from, and chemo virus that people don't have to travel for chemo again and sit in a bed for many hours a day, 45 times a week. And really patient control carried about getting people out with hospitals because they're really not nice places to be a on despite these fantastic ideas, because they really are good ideas on deadline of this being 2020 guess what? They're not really done either of them. What the hell is instead of three eights a system joint working on lots more organizations with even more acronyms on me? But these don't even have a low goes, which is poor. So they've created things like the sustainability and transformation partnerships, which are just ways for and just organizations to work together to modernize services on accountable care systems, which you like the next step up from STDs. But actually have some power on then places like Manchester have been devolved all over, and they were giving a little bit more care a little bit more control over that. What they provide. Um, so what they've done that is merged. Their clinical commissioning grips on there, created hospital chair chains, and things are called patient primary Care and networks, which basically means that within a certain area there are they're able to provide a lot more services. On bit means the patients are more able to access those services, But it also means that the patients I have traveled little bit further to get those. So this kind of benefits on down sides, um so to summarize for that And it just was formed based on the fact that if you make people pay for her health care, they went and I'll get another. I mean, basically thought that probably is about idea. So over the years, people come from June it if you try to get patients to pay more on more for parts of the healthcare because it turns out paying for everything from the government is probably quite expensive on do the stretch at the moment is run by basically a series of course organizations, old rubber rubbish, acronyms and terrible logos. I made a little slightly different things and all fall under the guidance of the Department of Health and Social Care That kind of try and work together to improve the health information whilst also at the same time, not crippling the economy. Um, Andi, if you wanted to line a little bit more about this, the King's fund has a really good animation about this where they go through this entire dot kind of background on, go through it all in a lot more detail. So, yeah, that's the end of I told you. Kept it nice and cold. So what for you. Thank you very much for listening. And do you have any questions at all? Thank you. John is actually really good ones that I left for you. Let me find them. Scroll. Back up. IRA up. That was a few answered. Answered. Um uh, access to slight. You know, someone's put what were the three in a chest? Founding principles. Yeah, So those were that it would be free at the point of use. So if you turn up the and A You've not gonna pay for it that it would be financed from Central taxation so everyone would pay a little bit. Whatever works would pay a little bit attacks on. But that would go towards paying for it and that everyone would be a little for care s. So it's not just people who live from the UK It's also people who are moving to the UK or also people that are, like temporary visiting the UK for the holiday or whatever. The first three, Um, then just to make a royal. So where I've put the feedback link in the queue and a 70 almost to see it there, let's say the certificate for attendance. Next question. How do you sell off services? I think they're, I think, last year there was some talk about how some of the chest was going to be bored by Trump admin. And what does this mean? And how does it affect us? So I don't even think about Trump trying to bypass that Jasper. I wouldn't put it past, um, it a lot of the NHS basically runs off a specific organization. Usually, CCGs make commission services, so lots of people turn around and go. For example, I am able, I run a company and I am able Teo, give you a certain remembrances to move patients, for example, from hospital or, uh, yeah, from hospital for the home when they discharged. If they're in a wheelchair or whatever and they'll bed and now go, that's a five companies that's able to do up, and usually they'll also be in any chest provided one that can do that. However, the setting off services basically needs that instead of going, you know what in London, instead of using the London Ambulance Services is the discharge team or instead of using, for example, Central ambulance does a lot better. But we're going to go for a private companies that are run for profit on. We're gonna pay them money to provide this service for us on what you have, Then, is that happening lots of lots of times on Do it essentially means that you're giving money, Teo. You're giving like government money for health and social cat to pray for four profit organizations, um two. Then provide the car or whatever service the an N H s. So that was previously provided on a good version. A good example is kind of ambulance services because they've done that a lot. That's kind of the main, but one of the main examples and raise it up. If that makes sense, thank you. They're just They're a bit also mentioned. I think on that point is no call. Things in the NHS belong to the NHS. Quite a lot of buildings and things that that will be rented. So that's the other thing. That's the other way you sell off services is you sell the buildings and then red in the back or you mortgage the buildings and you pay them off over a period of time. That's the trick that was used a lot in the noughties by the government to generate cash. Basically, you can make money in the short term, but you have to pay off in the long term. And it's part of why the NHS in such a big debt, um, there wouldn't be biased if m. H R A. It's sponsored by pharmacy to companies quickly to the type there about the safeguards in place. You got anything else that through the it's only the medicines part of it that funds that the healthcare devices side is funded by the Department of Health and Social Car. But I guess yes, in a way. But realistically, we're not America in America. That's exactly what they do. The individual companies go. I have a drug. I'd like you to sell my drug. I'm going to give you more money for my drug, so they choose that drug because they're going to go away. But yet we do have safeguarding and safe cards in place. Just actually say on it's essentially, like we're going to use your drug. I now like you to pay us for the use of the drug rather than companies. Kind of bribing and offering up prices, I believe. Yeah. Um, next one key, please go over patient controlled care. I didn't quite understand it. Yeah, it's the holiday or pain. Control is it's the patients. Okay, So if let's say you want the hospital where you went to GP on, do you go? I have this pain, um, in my leg or whatever. And the GP goes, I know I'm going to drink this. I'm gonna give you this drug and this drug only, and that's the only option I'm gonna give you on. Do you go? I don't get I don't really want to have that drug on They go for. That's your option. You're probably not gonna take that on a study show that if you don't like a vicious the options for things, they won't take it. So picture and truck areas, but going those about giving patients the options theophylline of kind of having some control over what they do and don't have in the health care plans. So you could say that you go. You know what? I can give you some party tomorrow, or I can give you some codeine. All I can refer you for physio and the patient goes, You know what? I quite like the physio people are more likely to, um, go along and kind of it here. Two plans that they're involved with. Likewise, if you were an ugly person with dementia and someone said you're going into a home now, you do not have a choice in which home you don't have a choice. Where you go, you're going there now. You're not gonna be very happy with her. Where is if someone says Well, we could take into home. Or actually, we could keep you. I will bring some carrots and kind of give you a love of a hand if he wants to go into a home in the first place. Great. You can do that. But actually, if you, um want t gonna stay at home with some carers, you could do that as well. It's about giving patients a little bit more control over back hair. It doesn't mean they can demand treatment. Definitely con, but it means they are more involved in the healthcare. And it also said you have shown that that means they're more likely to, like, adhere to that tree that Claire on, then therefore get better outcomes. So I think just to be clear, I've just taken over just a screen to share the green timetable cause someone asked for that earlier on. These are the sessions we have coming up. I just realized I need to change the feedback form for next week. That was going to ask you about two sessions. And there are more than two sessions, but it will be again the same time frame. Uh, Josh question. Have their bean any decisions made by the NHS after failing to complete what they have promised. Yeah, so there's quite a lot where they they cannot promise things, but then don't really on fulfill them. Um, I guess it depends on the specific decision. So the one I was thinking about for the health promotion Waas. I mean, 2014. I had that. Does it change for life like the advertising campaign with a little kind of I think they're like the remember change for lying to you. That was a service that was designed of, like the health prevention to get people. I'll get people in fruit, get people like making a better life choices in terms of the health. But that never really works. They never really followed up on it, and it's taking a long time to do it. Same for things like social prescribing, which is just coming in now, so social, prescribing a system where she pees can refer to a link blocker on the little working go. Here's all of the, for example, like charity things in the area, what you're looking for, how can we help on someone goes You know what I want to lose weight and they go, Well, here's some classes to learn about eating. Here's some cooking classes. Here's a free swim pass, whatever rather than the GP going, I don't eat my keys. So there's been a few decisions. Kind of like that, Um, help in that way. Um, but I guess it kind of does depend is kind of decision specific. Um, a lot of time. They just restricted any chest like they're restricting it all the time. Um, so I don't know, actually walked the Yeah. Yeah. Thank you, Miss Change for life changed. Life is the door. I've just tried to google the website for it. And this original website is now dead, which is really sad. So that's that one. Does the hs have any sources of income except from taxes? It's got a great Ormond Street one, isn't it? Yes. So charities a big one. A lot of any chest trusts in themselves will also have a concurrent charity to provide things on. They also have, uh, money talks based. Yeah, tax breaks chart. He's, um, and then specific governments that parts of government has specific what I use of like acquiring things depending on that specific board? Um, yeah, so I believe they gave. But the majority of it is Texas. Um, they also might have some think donors as well. I think particularly pediatric care tends to have external support because people are quite happy to fund Children. I think saying it's not so much if you put the name gosh on anything else any other. Like, for example, Great Ormond Street Hospital in London. They own Peter Pan because the guy who wrote Peter Pan gave it to them. So Disney have to pay them loads each year and rolled. Donald tried to donate all his complete works to them as well. And then they changed the law. See? And I'll have to do that anymore, which is quite sad. But otherwise the the FDA and all that we owned by the hospital. Uh, Josh was there ever be a situation where the government couldn't afford the NHS and we go back to privatized medicine? That's essentially what's happening in the bone. So they slowly give out services to different. Like private service is Onda. Then the funds just services and then go Well, look, this NHL service isn't working very well What we could do is hire out this private service on give them this contract, and sudden they will provide that occur. But actually in the weather, the problem in the last place is thie, um, funding. So it could be a thing. There's a lot of lobbying to turn it back into an insurance based system, but if you look at America that doesn't work. It's a horrible idea, but yet it depends very much he gets in control on. But if yeah, if we have, like years and years, very white, right wing governments, that's something that could happen. But the way the UK kind of politics system works, which kind of always bounce around where we are now on. But I think it's one most sort of It could happen in theory, but I think in practicality. I think the government that shuts the NHS is a government that will never be voted for ever again in reality. So I think every government will always continue to fight for the NHS in their own way. But just whether that way works is is debatable. Um, what needs to be improved about the structure of the NHS, your opinion. And then there's also one that ties into that, which is, if you could change anything about how the NHS works, what would it be? I mean, if I need the answers to these, I'd make billions and billions and billions be a very rich man, but I think essentially a lot of it is. No one talks to each other, so they provide lots of lots of different systems to go. We're going to talk to each other, but they're no, never actually talk to each other. So you got lots of services that are out there that no one knows about. So I think the social prescribing kind of system could Bringing that in will be very helpful, because that is a way of actually, But people talking to each other, reducing privatization away, so not paying at the way privatization works kind. It's going. We're just gonna pay this company loads of money to do this don't for us rather than having to do it ourselves and it being cheaper. That's so not privatizing parts of that. I'm bringing it ourselves. It's more difficult, but it's cheaper. That's something I think that's a lot of hospitals have outsourced departments in particular. So like to go to any trust. Their hatred are parts stuff. Aren't any chest off their private company page doing any chest job? Um, which again system set in place by the previous government. And it's still in place because really expensive to go back on on. Then I think the main thing is looking t stuff. Working conditions. So changed contracts and give stuff like actual reasonable jobs and not make them do, like, 72 hour shifts. Things like having actually useful. I t going away from paper medicine on If you could create one. You came wides, patient database, all of the patient notes that woods be can revolutionary. But that's just the dream. That and then having it accessible by an ambulance is well, so you just look up your arm. But that would just make so much sense that why would we do something we're allowed to have? Sensible only in the in nature? Um, yeah. No, that would be good for those. You haven't heard of melodies voice before. That's Melanie. She is gonna be part of teaching next week. Um, Melanie is a pharmacist. So that's why she can laugh at the rest of us wanting the sensible ideas because they're the ones who have to deal with the lack of sensibility. It's works. Could you go over the structure of the image s now, as it currently stands on? And then also, that's something about the NHS. Health doesn't have any impact on healthcare system's around the world. If everyone's happy with this green thing, I'll take it down. So just go back to his power point. You have to like Josh. Yeah. Just ask. Do you want to take control again? Oh, that's trying to find out. Yeah. You see that? Yes. Um, yeah. So very briefly. You've got, uh, got this guy and his boss is the, uh, um sexual estate for health and social car. Basically the boss of all of health care in the UK on. Do you have these people who run specific elements for him? Um, And then under that structure, basically, they run the department health and Social Cup, which does two things. So it funds interesting lung on any chest improvement. Energy's England is like today. Running improvement is stop spending all of our money. Um, and then a chest. England. Basically, it splits into basically delegates all of their work into CCGs on the CCGs doom. The majority of the work, then? Yep. It's into the CCGs decides invest specific area. Uh, which are these areas? Um, what services they want to provide in that specific area on they allocate the funding in that way. Then you have all of these different things which are all different organizations that kind of work and play into each other and do sometimes very similar symptoms. Very different drops on day. All work together, Teo run different parts of, then it just that's it. So she how it works, gorgeous, just quickly, because I'm here a couple of messages about it for the certificate stuff. Um, if you are not, share my one back again. If you are trying to this certificate and it won't let you make it in account because you're not attached to the university or a healthcare profession, you can probably just make the certificate and download. It should allow you to do that without making a count. It just means that you got people touch on. On top of that. I didn't realize it wouldn't let you make an account This you're attached to one until someone message me about earlier today. So, yeah, that should do that. Uh, does it impact any health care systems around the world? That's an interesting thought. Almost certainly. Initially it did three, and it presses kind of the first of its kind. Lots of places using insurance based system lots of places use just a private system because it's expensive on down places. Do a mixture of the twos like New Zealand is, I think, mostly tax base. They're trying to make a new NHS. Are they trying to build the British? I'll address now. I think it's mostly tax based that there is an upfront fee, but a lot of the time that small upfront fee is covered by insurance, I think is how musical marks they they are trying to move over to a fully British style and address. Currently under just in the garden is a P M who is very much in Anglophile and before being someone who is very pro Britain. She quite likes the British set up for a lot of things. Um, particular healthcare, other healthcare system's around the world. You want to be impact. I know for a while we were a bit the burden on Europe because we stole a lot of their sort of young, keen staff, like a lot of health care systems were trained up nurses and stuff. Then decide, right? I'm going to go work in the NHS for a couple years. Um, over. That's an impact, I don't know. But then likewise, quite let them go home, back to the country of origin. Once it had a few years in the NHS. They tend to get back more Syrian staff and we gain experience. You know, you get is that makes sense is sort of an exchange of we take they're juniors and then they go back when they're bit more experienced. House to invite to the healthcare services are they have one basic the NHS, the massive teaching pool. Like so many doctors, so many nurses come through the NHS that then go back into various other health services all the world over. Um, yeah, so that that Yeah. So I think that is off the impact we have, it's all the evidence that it can be done. So there's a lot of people in America that kind of like it's I think it's one of the reasons why America has brought in things like the Affordable Care Act because they know it can be done. And I'm actually America has a private system. It's mostly funded by, um, the people who use it. But it's also they also spend like the most on their healthcare system across the world on what they're realizing is is actually cheaper to do a taxation based system than it is to dio how America does it. So there's an awful lot being there and to kind of move it maybe towards an nhrc kind of weigh on lots of countries going rather than going entirely towards what injustice. They're kind of moving in that direction because they've seen it can be done. Um, the other one is a lot of services that use insurance based systems tend to be far more expensive actually, healthcare because if you're gonna be charging an insurance company that the hospitals happy to charge four times what they were going to originally message, please list of snowballing of prices person who said they accidentally make themselves a healthcare student on medal I mean, that works. But I will warn you, if you do try and make a healthcare Siris. Because this is what happened to me when I made this. They freeze your account and won't Rio reopen it until you send them photos of your I d for you knee next to your face to prove that you are the one with that account. It got really fiddly. See, I don't do that. Um, on you're very welcome. A mirror was just given some Thanks. That any last questions office? If anyone comes up with anything later on, feel free to email May. Like I said, I'll try and get through them quickly. Can also. Any queries about about the Siris Police feel free to do that. I'll email around the feedback link on. Hopefully will email around where you can access the recording of this. Um, that's the only problem with that one. Is we just like I said it right. And start my session. We haven't, um yeah, we haven't, uh, done this before, so it is a little bit of a learning curve for us is Well ah, Signed up for next note. Oh, email it all out to the same email address that we have this week. Obviously, if you know anyone who didn't work for and didn't get the email, they need to sign up again. There were a couple of email addresses that didn't really work, so I've had to sort of bounce them back and forth. Um, so, yeah, so basically, it's a long just so long as it worked for you this week. They're work for you again next week. If anyone had problems on, knows anyone who had problems ever email may or sign up again with a different email address. Because actually, some of the email address is particularly I cloud and Bt Internet didn't seem to like me very much. Some of them just thought that was spam, um, stiff in it. So if you fell out the feedback link, it should at the bottom of the feedback link, allow you to generate certificate. So long as you don't make a medal account, it should just give you in a downloadable format. Side effects, we know. Will it be recorded. So these sessions, I think automatically recorded, we just have to work out how and where to publish the live recording. On what? We're going to refer that back to our I t guy David, who helpfully knows what he's doing with these once we know what we're going to do with the recording and where it's gonna end up. Well, email everyone to be able to find it. Um, they go, It should be available. Vial. Original link. Interesting. Thank you. Anonymous for that one. Um, if that what doesn't work? We were talking about potentially putting it on a YouTube channel. Some of this. So we might just email around a link for that there Alaimo around the feedback link as well, so that anyone who missed it in the chance or he wants to afterwards go there. Uh, yeah. There's asking to start what sign up has. Ultimately, it shouldn't make you sign up. You should be able to do it without otherwise just say you're some sort of healthcare student, and it should let you do it. Ah, you must not do the, uh, do the link. We won't be emailing. Stick it. Do violent. It should allow you to do it without making an account. Um, so I missed anything interesting and it sounded next week. No. Should get the same thing. The bomb. Some people are just getting away with it by making account, claiming their healthcare students. Ultimately, it's not wrong. It's probably a bit ahead of schedule. Maybe. I imagine a lot of you're planning to go into some sort of healthcare. Obviously. Don't go and claim. You know, you're a doctor or a nurse or anything like that before you are, They're protected titles. Um, I think so is a pharmacist. And I think so. The paramedic these days. But if you just claim general health care, I think that's okay. Ah, I sent the link on the chest. If you scroll up, it's there. Otherwise I will email it to the same emails used to look in. Um, I don't know about where you find it in metal. Um, yeah. Okay. So you have a look on the link apparent if you want to re watch. Ah, I mean, yeah, screen shot in the certificate. Saving. It's a word a guest would work. Ultimately, it should give you in a downloadable format. If it doesn't. I'm not really sure. I'm I'm not I t guy really are just No metal a bit from being the from having used it as a candidate like cells. Before I'll republish um, link. There's the feedback link again for anyone who didn't get it before. I really lost among the chapped for the time being. Otherwise, I'll leave this thing running for a couple more minutes to give you guys a chance to find that and just in it for anything you want to look through. But as the people have said, it should be available to watch the recording almost immediately. It's not officially think thank you. Everyone who showed up tonight. Hopefully it a good time and hopefully see you guys a call next week and massive thank you to Melanie and Josh for all your help this evening. Very welcome. And none of us. Yes, they will be a civic it for every week. So you each week will have to or where she next week this four segments like this and you'll get one certificate, which will say both of them on it, saying which I need to go and generate the link for the next couple of weeks. Uh huh. A liver E. Welcome. Someone here. Ask if they miss one of these? Yes, that the links when we know how we will stick it somewhere for you. Are you on YouTube or 12? I the link. Yeah, I'll be available. Welcome. Welcome. Welcome. Welcome. Those of you still in this? I'm about to end it in about 30 seconds. So if anyone needs anything out of the chat, please do, um of wise, you can email me and I could send you the link individually on. That's a long time ago for thank you all very much. Message me if you have any problems.