WELCOMED: Proposals to Close Sunbed Regulation Loop-hole

Today the National Assembly’s Health Committee publishes its report looking into the use and [serious lack of] regulation of the sunbed industry in Wales.

A clear message to discourage the use of sunbeds was sent out earlier this year following the success of our campaign to get local authorities in Wales to remove the sunbeds they operated in their local leisure centres.

Now the Welsh Assembly has the opportunity to develop on that, to steal a march and introduce adequate measures to regulate the commercial tanning industry and thereby protect public health in Wales.

The Health Committees report makes for very interesting reading, and while I would pick the Committee up on a few, very small, points in the document (as you would expect, you might say), BMA Cymru are absolutely delighted with its conclusions.

The report shows that the Committee has listened to the evidence it received – not just from us and the wider healthcare profession - but from a whole host of organisations and even from parents.

In line with our recommendations the Committee is asking the Welsh Government to “seek the legislative competence to introduce new laws to enable local authorities in Wales to regulate, license and, if necessary, impose liabilities and create offences in relation to sunbed facilities and their operators.”

Again, in line with our recommendations, (link) the Committee says that these new laws should be based around recommendations 1 and 2 of the thirteenth COMARE report on ‘The health effects and risks arising from exposure to ultraviolet radiation from tanning devices”.

As a minimum, the law should ensure that:
• use by under 18s is prohibited;
• use by other high risk groups is discouraged;
• facilities provide full-time supervision by well-trained staff;
• use of protective eyewear is compulsory;
• information setting out the potential health risks of using sunbeds is prominently displayed and provided to all users;
• information containing unproven health benefits of sunbed use should be prohibited from premises;
• written informed consent is obtained from all clients prior to use; and that
• facilities should not be allowed to use sunbeds that do not comply with both the British and European Standards on sunbed irradiance levels.

We will be urging the Health Minister and the Assembly Government to adopt and bring forward these proposals as soon as possible.

For us the essential point is that there is no such thing as a safe tan (unless it comes out of a bottle). The damage to your skin remains long after a tan has faded.

There is one area of regulation of the sunbed industry which we would like to see Wales go further on – that is advertising.

Although the report suggests that investment in the SunSmart campaign is needed on a UK level - bill-boards, posters and leaflets advertising commercial outlets continue to line most high streets in Wales. Although I’m not aware of any detailed study to date, I think it’s fair to say that these tend to be targeted towards our more deprived communities – and towards young people.

In our view a move to place tighter regulation on the commercial sunbed industry - including inspection and licensing, a restriction for under 18s and a ban on unsupervised salons - would be significantly more robust and complete, if it included some level of control on advertising and marketing.

HIV Related Discrimination by Healthcare Professionals

I’ve just got back from the Assembly, where Dr Tony Calland and I gave evidence to the Equality of Opportunity Committee on discrimination against people living with HIV by healthcare professionals.

This by its very nature is a difficult issue.

But it’s compounded by the fact that there is no real evidence base in Wales from which to work from – at the moment the evidence of discrimination (by doctors and other health care professionals) is anecdotal.

And therein lays the problem. This lack of comprehensive evidence base is what the committee is working from; and as Jonathan Morgan AM points out they well struggle with this particular inquiry.

Advances in medicine and the ‘normalisation’ of how the HIV virus is treated have challenged much of the stigma previously found in healthcare settings.

That is not to say that discrimination is not occurring. I accept that unfortunately it may well be.

As we said in our paper, discrimination of people diagnosed with HIV by any healthcare professional is unacceptable, and is a breach of fundamental human rights – rights that are central to the practice of medicine.

Discrimination - whether actual or perceived - has a negative impact on health outcomes, and contributes to both a reduced use of prevention services and perhaps a higher rate of onward transmission. I suspect, however, that this point is obvious to most people.

Surprisingly perhaps, what’s less obvious to many people is what actually constitutes stigma and discrimination – and the effect that it can have.

Any drive to combat this should be directed at the whole healthcare team (managers, doctors, nurses, receptionists, social workers, clerks).

Non-HIV specialists may feel a lack of confidence in treating HIV patients – even if they present with common complaints. I would argue that for these clinicians, a tendency to refer HIV patients to specialist clinics or consultants arises from a lack of specialist knowledge and a desire to do right by the patient, to ensure they get the right care, rather than a reluctance to treat HIV patients on the basis of prejudice or discrimination.

This applies to many other conditions, such as diabetes and cancer, not just HIV.

It’s also important to remember that clinicians employ universal cross contamination measures for all patients (e.g. see 1000 lives campaign), because every patient could potentially have, for example, a blood borne virus or transmissible infection and are so far undiagnosed.

Precautionary measures which may seem to be over-the-top are often standard clinical practice.

A lack of knowledge about HIV, and misconceptions about onward transmission, fuels stigma and discrimination. As Dr Calland told the Committee this morning – ignorance may be the problem not prejudice.

I will follow the Committees inquiry with interest, and in the meantime we are planning to meet with the various organisations and representatives in Wales to see how we can improve on this agenda, jointly.

Some Good News on World Stroke Day

You might have read elsewhere that today is World Stroke Day. And that to mark the day, its been announced that an NHS initiative to speed up the treatment of stroke victims is being rolled out across Wales.

A very welcome development.

BMA Cymru recently gave evidence to the National Assembly’s Health Committee on stroke services in Wales as part of the professions ongoing campaign to improve what is one of the worst performing areas of the NHS in Wales. In almost every aspect of stroke care Wales lags behind the rest of the UK.

The new NHS initiative, overseen by the All Wales Stroke Services Improvement Collaborative, has been created over the last twelve months. It is about creating new ways of working to ensure that all stroke patients in Wales have access to automatic emergency care, and receive faster relevant treatment.

In Wales 11,000 people have a stroke each year, it’s the leading cause of disability and the country’s third biggest killer - yet for some reason Stroke hasn’t quite hit the radar of Joe Public as a major health concern.

Perhaps it’s because traditionally stroke has been seen as something that only happens to older people. That’s no longer the case – stroke can and does affect anyone.

Or perhaps it’s because in the past stroke was not considered a medical emergency. But now it’s well established that stroke victims require urgent and prompt specialist assessment and treatment – and that this is the greatest determinant of both survival and recovery.

Either way, the theme of this years World Stroke Day ‘Stroke, What Can I Do ?’ gets to the heart of the issue: that Strokes are preventable, and there is a whole lot that we as individuals can do.

Like so many other health conditions, most strokes are related to overall health and wellbeing. Almost half of all strokes in Wales could be prevented by regular blood pressure checks and by taking steps to improve overall health. I noticed that Joyce Watson AM has done some work on this issue this summer and out of the 1000 people whose blood pressure was taken, a third returned high / borderline readings – a major risk factor for stroke.

Individuals can also do something important just by knowing the symptoms of stroke, how to recognise it and what to do about them – knowing that a stroke requires a 999 response.

Our clinicians and other healthcare partners are struggling to manage the volumes of stroke patients in Wales in an environment which has a severe lack of specialists, which has far from adequate acute care provision and where rehabilitation services, to put it very mildly, are patchy.

Whilst we welcome the news that the new scheme is making improvements in stroke care in Wales – there is much more that the Assembly Government needs to do if Wales is going to achieve the standards seen elsewhere in the UK and begin to provide even an adequate level of services for stroke patients.

To that end, we have made series of recommendations on the steps that should be taken – nationally and more locally - in order to improve the provision of stroke services across Wales. Some of these will need investment, and in the current climate we realise that tough choices have to be made – but money should be chasing need and this is one area of healthcare that Wales can no longer afford to lag so far behind on.

As a priority we need to attract more stroke specialists to Wales while promoting stroke as a speciality to medical students and Junior Doctors; we must improve overall staffing levels including the number of dedicated sessions consultants can allocate to stroke care; and everyone in Wales should have access to a dedicated stroke unit (with appropriate rehabilitation and support services attached) within 30 minutes travel distance from their home.

Significant investment is needed at the acute care level, but the focus needs to be on the whole stroke journey.

What Wales needs is a comprehensive action plan on stroke.

Out of Sight: Out of Mind

Yesterday saw a historic victory in preventing children and young people from taking up the deadly habit of smoking as Members of Parliament voted to end the display of tobacco at the point of sale AND to ban the sale of tobacco in vending machines.

With most smokers becoming addicted before their mid-20s, it is essential that we try to prevent young people from taking up smoking in the first place. Making tobacco an ‘out of sight’ product is a huge step forward in protecting young people from a lifetime of smoking and will reinforce the increasing unacceptability of smoking.

The Health Bill 2009 will enable the Assembly Government to implement these measures and - as a Member of the Wales Tobacco Control Alliance - BMA Cymru is joining calls for this to be done as soon as possible. The Bill represents a brave move against a powerful international tobacco lobby which employs multimillion pound marketing tools aimed at recruiting new young smokers.

In July 2008, the BMA produced a report, Forever Cool: The effect of smoking imagery on young people. This report examined trends in smoking prevalence and initiation and it reviewed the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people.

The fact that the Health Bill was amended to include a ban on tobacco vending machines without the need for a vote shows the strength of feeling in the importance cutting off the supply of cigarettes to our young people, de-normalising the deadly habit and preventing the onset of smoking.

Reporting patient safety concerns will lead to better patient care

Today the NHS National Patient Safety Agency published the latest incident report for NHS organisations in Wales. The information is compiled from reports from frontline NHS staff and is published twice a year.

Today’s publication shows that 90% of all patient safety incidents result in no (67.9%) or low (22.1%) harm to the patient. That leaves 10% of reported incidents which are classed as moderate (8.2%), severe (1.4%), and contributing to death (0.4%).

The figures include incidents that did not result in any harm but had staff not identified it, could have done so. Overall the proportion of serious incidents has remained stable as reporting rates have increased. The most commonly reported incident type were patient accidents (36.4%).

Patient safety is a top priority for anyone working on the frontline in the NHS in Wales. That’s why the BMA is such a strong a supporter of the 1000 Lives Campaign and has worked so hard to continually improve patient safety, and therefore improve patient care. For us, the safety and quality agendas go hand in hand.

There is a lot of good work being undertaken in Wales to improve patient safety, and in representing the medical profession we are keen to see that develop and expand in the new NHS Wales. Earlier this year we published the Speaking up for Patients report - based on survey responses from 565 doctors working in hospitals in England and Wales.

Almost three quarters (74 %) said they had had concerns about issues relating to patient safety, malpractice or bullying, over the course of their NHS careers. Within this group, 73 % said their concerns had related to standards of patient care.

Seven in ten doctors (70 %) who had had a concern raised it with the relevant authority at their trust. However, many said that their experiences of reporting issues had been negative, for example because they were unaware that anything had happened as a result, they were not approached for further information, or the information they provided was shared more widely than they were comfortable with.

A significant proportion (15.5 %) of doctors who reported concerns said that their trusts had indicated that by speaking up, their employment could be negatively affected. Despite these experiences, around three quarters (74.5 %) said they would be prepared to report concerns again in future.

In the minority of cases where doctors had not raised their concerns, this was most commonly because they were not confident that it would make a difference (81%).

I think we can conclude from this that organisational support is absolutely paramount to improving patient safety across the NHS.

The information published today will be vital to the new LHBs in Wales when setting local priorities and identifying areas for action. LHBs and healthcare professionals will be able to compare patient safety performance (in like-for-like service areas) across Wales. To improve that performance, they must provide an open culture of organisational learning by ensuring that patient safety is a high priority, and by encouraging and facilitating incident reporting.