2009 resolution to the WAG “Don’t leave doctors out in the cold this New Year”

As Chair of Welsh Council, I, like Richard would like to wish everyone all the best for the New Year. I'd also like to elaborate on Richard's comments about the challenging times facing doctors in the Welsh NHS, in 2009.

As we face another reorganisation of the NHS we could well ask ourselves "what is different about this one, from the numerous ones we have faced in the past?" This is a good and important question.

I think this one is different because of the underlying change of direction. That is, to dismantle the market place, the purchaser-provider split, with a return to a strategic planning of services. Also, the stated Ministerial aim to put doctors and other healthcare professionals back into the centre of decision making in the NHS and the services for patients, is to be welcomed.

We need to now be considering how best to be involved in the process of planning patient services in this new system. I know many of us will have doubts and bad past experiences. We have all had those. But I think we have a good opportunity now to get back to being influential, to be listened to and helping to change patient services, instead of having changes imposed on us, by those often furthest away from actual patient care.

If we don't get involved now, I think we will miss the chance that may not occur again for another 5 to 10 years. That will be damaging to patients and the care they receive.

But that said, as we doctors reflect on how best to involve ourselves in a way that best benefits our patients in the new Welsh NHS proposals, we would urge the Welsh Assembly Government and those who manage health services in Wales to make a New Year's resolution...don't let the commitment to a greater involvement of doctors and other health professionals be a passing phase, or one of those New Year's resolutions that start with good intentions but fade quickly as the New Year moves on. The medical profession in Wales is eager to rise to the challenge of making these new reforms work for the people of Wales - don't lose our confidence and trust by reneging on that Resolution and side-stepping doctors. This is a pivotal point for the NHS in Wales. Don't risk throwing away the seasonal goodwill of the profession in Wales.

Andrew Dearden,

Chair of BMA's Welsh Council

Dedication of doctors in Wales shines through

On the Friday before Christmas, one of my relatives unfortunately had a fall and fractured a wrist. I had to accompany my relative to our local Accident and Emergency Department, at a well-known Trust in Wales. I have to say that the whole experience - while not one I doubt anyone would particularly choose - couldn't really have gone much better.

After a reasonable wait in the A&E department, with a computer system that easily found my relative’s details, we were quickly ushered into the treatment area. From the initial examination and assessment by an able, capable and professional young Casualty doctor, through to the x-ray department and the high-tech digital x-ray facilities, to the Treatment Room and reduction of the fracture through to recovery and an overnight stay on the Ward - the whole experience demonstrated yet again the absolute dedication and professionalism of doctors in Wales and other healthcare professionals.

Irrespective of political and managerial reform of health services in Wales, or elsewhere, the one abiding and unchanging aspect of health is the need of the individual and the skill and the dedication of the doctors able to deliver it.

Season's Greetings

Wishing all our members and your families a Merry Christmas and a Happy New Year.

There will be big challenges for the Welsh NHS and all those who work in it, in 2009, none more so than the plans to restructure the service.

We will make sure BMA Cymru Wales plays as full a part in the consultation as is possible, starting with the BMA's Policy Day on January 7th.

Best wishes to one and all.

Selfishness could cost lives

With the many stories that are in the Welsh media on an almost daily basis about people waiting hours for an ambulance to turn up, I find it staggering that it’s reported in the Western Mail today that people seem to think it OK to call 999 because their cat had a cut paw. Or, because they can’t reach the TV remote control. Surely I’m not the only one who thinks this completely absurd and an absolute waste of time and money. I think by now, most of us are aware of the extra pressures on the Welsh NHS at this time year. We’ve already had an exceptionally cold winter, with hospitals across South East Wales struggling to cope with the demand for beds. So time wasters ringing for an ambulance, when it quite clearly isn’t an emergency, does no one any favours, least of all those who GENUINELY need the help of paramedics.

In this season of goodwill to all, perhaps it would be a good idea to be a bit more considerate and only dial 999 in an absolute emergency.

New junior doctors DVD - training the best to be the best

The BMA in Wales hopes a new video, aimed at medical students will help to put Wales on the training map.

BMA Cymru's worked with the Wales Deanery for Postgraduate Medical and Dental Education, to produce this DVD for students, giving an invaluable insight into medical training here.

The aim of the video is to “sell” Wales as a key destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here.

The series of short films focuses on five different specialties – Anaesthesia, Obstetrics and Gynaecology, Paediatrics, Pathology and Psychiatry. It was shot on location at hospitals around Wales, with junior doctors and their seniors revealing in their own words, some of the highlights of training, working and living, in Wales.

Wales has a great deal to offer, both in terms of quality of life and the quality of training provided and this is clear throughout the series of short films. The nation can more than “hold its own” with the best of the rest that the UK has to offer.

All doctors who are short-listed for interview will receive a hard copy of the film film, as part of their information pack.

Some BMA members may spot themselves on the small screen, no doubt Oscar glory now beckons!!!

Don’t bank on ending up in the “drunk tank”

I can’t really say the front page of the South Wales Echo today is an idea for Wales to be proud of. Plans for a “drunk tank” for those in Cardiff who’ve had substantially more than “one too many” seems like a necessary evil. On the one hand letting revellers “sleep off” the affects of drink in an inflatable tent is perhaps the safest and sensible measure for all concerned.

But, at the same time, it’s also very worrying. There has been a lot written recently in the media (and on this blog) about binge drinking and how it’s rapidly becoming the new scourge of our society. So it would be a mistake to view these tents as a permanent fixture in our city centre centres. Most of us will end up having a few drinks over the Festive period, but let’s hope it doesn’t result in the majority of us ending up in a tent, by the Millennium Stadium.

BMA welcomes consultation on the use of 084 numbers in the NHS

The announcement by the Department of Health that it's to launch a consultation on the use of 084 numbers by GP surgeries should be broadly welcomed.

The whole point of using phones to contact a GP, is to make it easier for people to get in touch with surgeries. But it should also be a cost-effective system for patients.

There is strong evidence that patient satisfaction has improved where the 084 numbers are used, with better and quicker access to services, because these telephone systems have added functions. GPs do not in any way want to profit from patients. But perhaps the public may think the added convenience these numbers provide, make the (usually small) additional cost worth it.

Let's not forget as well, that GPs were encouraged to switch their numbers in the first place to ensure better access for patients. And it’s not just GP surgeries which use these numbers, NHS Trusts do as well.

As the DoH has decided this issue now needs addressing, maybe it's time the Welsh Assembly Government did the same, so the Welsh public aren't paying more than those across the border, to get a GP appointment.

Medical profession is taking the lead on improving NHS standards

The medical profession wants to lead the way in continuing to drive up standards of care in the NHS.

I'm saying this with regard to today’s Healthcare Commission State of Healthcare 2008 report.

The overall picture in this report is of major improvements to standards of care. BMA Cymru Wales applauds the efforts of NHS staff in reducing the amount of time patients have to wait, and improving the quality of the care they receive.

Unfortunately, the report contains the misleading suggestion that up to 600 errors happen in primary care a day. This is based on data which was mainly gathered outside the UK, and identified that medical error occurs between five and 80 times per 100,000 consultations.

Any errors are of course, regrettable, but there are millions of contacts between the NHS and patients every day. It is inevitable that, in a very small proportion of these, care falls below the highest standards. Doctors want to get rid of unacceptable variations in quality, but we need to be careful to analyse and learn from the causes of low performance rather than jumping to conclusions or simply adopting a blame culture.

Clinical leadership and engagement are essential elements of efforts to drive up quality which is why doctors are working with the NHS to develop new quality measures, including how patients feel about the treatment they’ve received.

Smoking displays ban doesn’t go far enough

I do very much welcome the move by England’s Health Secretary to ban the open display of tobacco in shops across Wales and England. It should hopefully make smoking less accessible to youngsters.

Research shows that point of sale displays does encourage youngsters to take up the deadly habit.

I do however also understand that plans for an outright ban on tobacco vending machines and branding on cigarette packets have been scrapped, which is somewhat disappointing. I would have liked the Department for Health to have gone a step further, by scrapping the sale of packs of 10 cigarettes and getting completely rid of tobacco vending machines.

New dawn for the Welsh Lib Dems

So the waiting’s finally over and by now, no doubt most of Wales knows who the new Liberal Democrat leader in the Assembly is. I and the rest of BMA Cymru Wales would just like to offer our congratulations to Kirsty Williams, AM and wish her every success in her new role.

Some remedies to a lack of beds of in Welsh hospitals

The recent situation of a lack of beds across hospitals in South East Wales I have to say, was not entirely unexpected. BMA Cymru Wales did warn that a reduction in bed numbers would lead to an in-balance in capacity. We need to stop cutting bed numbers and get back to a situation of sensible bed occupancy rates. I understand hospitals are currently running at 82% rates, although I’ve been told in some Trusts it’s even higher than that, at over 90%. This leaves no room for manoeuvre, so hospitals are then unable to cope with any peaks in demand, which is particularly acute in Winter. It’s creating problems which could be anticipated. There really is no need to have such high bed occupancy rates. Any that reach over 75% can lead to an increased risk of hospital acquired infections such as MRSA and discharging patients too early to try and free up beds, merely results in those patients being re-admitted, creating a false bed occupancy economy.

More focus is needed on making inroads in transfers of care. Small differences have been made, but statistics highlight how managers are unable to pin-point the obstacles to discharging patients. I think a taskforce is needed to look into the appropriate care environment and a case by case analysis of the obstacles when trying to free up beds. If we could make just a 10% difference, that would equate to the freeing up of 50 beds.

Stopping people from coming into hospital unnecessarily by developing primary care services more, would be another way to address the problem. Providing these services closer to patients’ homes when appropriate, could ease pressure on hospitals. I know there is a desire from the WAG to pursue this in the current NHS reforms, but it is difficult to see how they will be completed in a speedy fashion, especially when there seems to be a lack of development in primary care, especially with regard to premises not being invested in. How on earth are we going to address the expansion of staff needed for the changes in primary care, if we don’t have anywhere to put them?

The Welsh Ambulance service needs to be considered in all of this too. Is this being appropriately resourced, so that it can operate to best effect? The service has a huge potential to be able to deliver alternative care models and avoid having to take everyone who rings 999, automatically to a hospital.

There is a definite requirement to streamline and simplify how we access unscheduled care. Patients are confused by the pathways they need to take. The DECs project was established to address this. But it needs to be moving quicker, so patients are seen at the right place and at the right time. At the moment patients have a vast array of options, and go for what they think is the quickest and easiest, a trip to A&E.

Ultimately, health professionals, working on the frontline of the NHS everyday, need to be listened to. They have the solutions and unless they’re involved in intricate, high-level decisions with managers, these recent problems seen in South East Wales, will worsen and spread.

WAG puts the development of GP practice premises on hold

I am extremely concerned that the National Assembly Government has put a stop to the development of GP practice premises across Wales, whilst the NHS reorganisation takes place.

Recently, they gave an instruction to Local Heath Boards to immediately stop planning for projects in primary care in Wales. This means that patients who have to visit their doctor in unsuitable surgeries across the length and breadth of Wales, will have to wait years before they see an improvement in building standards. It also means that many doctors will have to work in premises they know are inadequate and not fit for purpose.

Chairman of the BMA's GP Committee, Dr David Bailey has given this reaction: "Despite claiming that one of the Government's stated aims is to move care out as much as appropriate into the community closer to patients’ homes, there is now significant planning blight on primary care premises development. To me, this seems, to say, the least illogical.

"GPC Wales is fully supportive of the drive to move care closer to patients homes and utilise the skills and expertise that exist in primary care. However decisions such as this – ostensibly to allow planning by new organisations not expected to exist until 2009 – seem to demonstrate a worrying lack of joined up thinking and will have an effect on morale in primary care, probably much greater than the actual delay in premises development."

"We would urge the Government to reconsider the issue of this advice and allow LHBs to continue to develop primary care estate and the capacity of NHS Wales right up to the moment they cease to be accountable for these important responsibilities.

It is totally unacceptable that both patients and GPs will have to put up with inadequate premises whilst the NHS reorganises itself - a process which will take at least a year to bed down."

We need to stop this threat to the DTB

I am astounded to find out that a key clinical publication is being restricted to clinicians across Wales.

The Drugs and Therapeutics Bulletin (DTB) which is currently sent to all doctors, I’m told, will soon be rationed. It is incredible that the Health Minister has made this short term decision that funding for the Bulletin is being restricted for nine months and then ended completely.

The Minister's decision to cut the distribution of the DTB to one copy per GP surgery and one copy per hospital department until March next year, and then cut funding altogether after that, is one that will impact heavily on the ability of doctors to treat patients safely.

The Bulletin is a vital tool for doctors, which is now in jeopardy. It gives independent advice on medicines and is an indispensable publication for any doctors prescribing medicines to patients.
If the Welsh Assembly Government values doctors and other health professionals, limiting the provision of 'tools of their trade' is a strange way of showing it.

Evidence based prescribing is essential in order to provide good quality healthcare to patients. Complications through both overuse and underuse of drugs can lead to emergency hospital admissions and the wastage of medicines, causing unnecessary costs for the NHS in Wales.

While I agree that with technology moving into a new dimension and confirmation that the DTB will be available to all clinicians electronically, I’m still concerned that not having the bulletins available in paper form could cause problems with homes visits and emergency call outs or if computers fail.

Only last year, the Government attempted something similar, by trying to limit the distribution of the British National Formulary. This provides healthcare professionals with authoritative and practical information on the selection and clinical use of medicines in a clear, concise and accessible manner.

My colleague Dr Andrew Dearden, Chairman of the BMA's Welsh Council is also incredulous about the plans for the DTB and has passed these comments on to me: “This move by the Assembly Government to de-fund an important part of the NHS’s information system about drugs, is indeed strange. This bulletin plays a vital part in medicine safety and in helping doctors choose the right drug for each and every patient in Wales. When the Minister says she cannot afford to make sure each practising clinician has this up-to-date information to hand, she is, in effect, saying she cannot afford patient safety.”

Where Wales’ rugby team leads, the NHS should follow

I can’t let this Monday pass without offering big congratulations to the Wales rugby team after their inspiring win at the weekend. The determination and tenacity of all players involved in the Southern Hemisphere scalp, bodes well for the future of the sport here.

Amidst all the celebrations though, I was disappointed to hear about Jamie Roberts’ injury and wish him all the best for a speedy recovery. It’s clear the medical student has a bright future both in rugby and hopefully, the Welsh NHS.

The successes of our national side this year must in part come down to the strength of the management set up. Since Warren Gatland came in as coach, he’s worked on building solid foundations and a professional capacity so that Wales can compete with the best teams in the world. By getting advice from the best in the business, we have a team that Wales wants, needs and deserves.

We can consider the reform of the Welsh NHS in the same way, as the change in fortunes of our rugby team. The proposed changes provide an opportunity to give patients an NHS they can be proud of. Decision-makers have the opportunity to take the best, appropriate professional advice, undoubtedly from doctors who know more than most how the service runs, being at the coal face of the NHS every day. If the WAG looks to doctors when implementing the reforms, then they will be going a long way to ensuring our NHS is as successful and inspiring as our rugby team was at walloping the Wallabies.

Health inequalities in Wales are widening

Wales' Chief Medical Officer's annual report contains some very positive plus points, not least the fact that people here are living longer and that deaths from heart disease and strokes are continuing to fall.

A main reason for this is undoubtedly the investment in general practice, starting to bear fruit. With GPs focusing on cardio-vascular prevention as part of their QOF targets, that is then being passed onto the patients, and they hopefully have a better understanding of how to manage conditions such as high blood pressure and diabetes. So we can see the clear link here between investment in primary care and positive health outcomes.

On the other hand, it is rather disappointing to see in this same report, how the gap is widening in the rate of deaths from cancer, between the rich and the poor. Which begs the question are we focusing enough on those in deprived areas? And the answer seems to be a resounding “no”. There has been a lot of rhetoric and SOME investment, but to drive down these inequalities, it isn’t happening quickly enough. Without greater strategic enhancement in primary care services and Public Health to tackle people’s lifestyle choices, the situation will remain the same. And these strategies need to start at school, so children understand as they grow up, what a healthy lifestyle is.

I can’t stress enough the importance of Public Health to improving the nation’s health and therefore, we mustn’t lose sight of that in the restructuring of the Welsh NHS, currently taking place. It is of the upmost importance to ALL of us, but particularly the less well-off, that the right doctor workforce is put in place, for generations to come.

Study highlights the need for greater awareness surrounding obesity

Nearly three quarters of Welsh children don’t realise a eating mainly junk food, could lead to potentially fatal conditions like diabetes and heart disease.

This is the startling finding of study by the British Heart Foundation. Apparently, children think the worst health effects of eating junk food are merely putting on weight and rotten teeth.

This highlights just how little youngsters know about and understand the relationship between the old saying "You are what you eat". So I think the BHF has come up with a brilliant and innovative way to try and get this message through to kids.

The charity's developed an online computer game, the Yoobot, hopefully helping them understand the long term consequences of a poor diet. It allows them to create a mini version of themselves, showing how the choices they make for their Yoobot (about food and exercise) have a direct impact upon their health and wellbeing. Perhaps after children have finished this, they'll be encouraged to move away from the computer screen and go and kick a ball around or ride a bike!

Strong action, not just words is needed to tackle violence in the NHS

Strong action, not just words is needed to tackle violence in the NHS
I'm glad to see violence against NHS staff is on the agenda for discussion in the Assemby today. However, I would rather it wasn't even a problem that needed discussing in the first place. I find it quite incredible that anyone would want to attack the very people trying to help them and make them better.

Violence towards doctors and other health professionals sadly isn't a new phenomenon either. It's certainly getting worse. More than a year ago, BMA Cymru called for all ALL frontline healthcare workers to be given a free personal attack alarm to help protect them.

In Wales, there are some 22 cases of violence or aggression reported by NHS workers each day and estimates suggest that it costs the NHS more than £6 million a year. This would also seem to suggest that the Welsh Assembly Government isn't getting to grips with the problem.

Let's stop and think about the victims here too, many of which are BMA members. I know from speaking to some, just how terrifying it can be to face someone aiming a punch at you, when you're just trying to locate the cause of that person's chest pains. It's pretty much taken as a given in some professions, such the police, that at some point during the course of your work, you will encounter violence. It certainly shouldn't start becoming "acceptable" if you work in the Welsh NHS.

The Welsh Assembly Government and NHS Wales are already committed to a zero tolerance approach towards violence and abuse of staff, with a working group making the following recommendations;

1. Police should be patrolling NHS premises to deter perpetrators of violence and reassure patients and staff

2. Extend the use of CCTV and one work alert sysem

3. The existing all-Wales violence and aggression training passport scheme should be incorporated into all NHS staff training

4. Trusts must ensure they work with the CPS to ensure the effective prosecution of perpetrators of violence

5. Employers must encourage and support victims to act as witnesses in any prosecutions

6. Staff should have free access to solicitors to pursue prosecutions and the recovery of additional costs incurred resulting from violent and aggressive acts at work

BMA Cymru fully supports these and hopefully this afternoon’s debate takes into account the recommendations too. We would welcome the practical implementation of them NOW to protect staff and send out the right messages to the violent and aggressive few. We need to reverse the current trend of increasing violence, or else we face a situation where people will be put off entering health care roles and those health professionals already in them, leave - at a time when NHS Wales cannot afford to lose employees. BMA Cymru urges WAG to get tough on this, sooner, rather than later.

Overhaul of the sick note system is long overdue in Wales

The package of measures announced today to get people in England back to work and to help them stay in work, looks like being a step in the right direction. Perhaps it's something Wales should consider adopting.

The BMA has been calling for the sick note system to be reviewed for many years and we believe a Fit for Work service to help people back into employment may be the right way forward. The new ‘fit note’ has potential, particularly were it to be introduced to Wales, where we have some have the highest rates of incapacity benefit in the UK.

Whatever the change to the system though, it's crucial GPs are able to continue to act as the patient’s advocate and don’t end up policing the system for the Department for Work and Pensions. GPs are required to provide facts (not opinions) and do not take decisions on who gets benefits. That is the way is should stay.

It would also have been good to have seen a commitment to making sure every worker has access to basic occupational health services. Employers do need to take more responsibility, particularly in difficult economic times like now, as work-related ill health problems may well become more common.

Hidden and human cost of the credit crunch

A top Welsh police chief says there could be more victims of domestic abuse, as the credit crunch takes hold. If that's the case it's a sad, and very disturbing consequence of economic hardship.

Gwent Police chief constable Mick Giannasi says there is evidence of more tensions behind closed doors, as families worry about money.

Of course, the stress of finding enough cash to pay the bills and feed the family all adds up to more pressure on the breadwinner(usually male). But there can never be a valid "excuse" for violence in the home.

The BMA is aware its members can play a part in getting this hidden issue more out into the open, previously calling on doctors and all health professionals to be increasingly aware of domestic abuse. Doctors need to ask their patients the right kind of questions about attacks in the home and respond appropriately. They need also to be given training in dealing with domestic abuse, to "spot" the signs.

Today, on White Ribbon Day, here are just two alarming statistics, highlighting the depth of the problem.

Domestic abuse is THE number one cause of death for women across the world, aged between 19 and 44.

Domestic abuse accounts for 50% of women who are murdered.

View the YouTube video detailing our success over junior doctors accommodation in Wales

Barriers in hospital car parks inevitable consequence of abuse of system

So, Swansea's Singleton hospital has finally had to bite the bullet and invest in car park barriers to stop people who aren't actually going to the hospital, from parking their cars there.

Since free parking at Welsh hospitals was introduced earlier this year, it's been noted in the press, just how many people are taking advantage of the changes. I even blogged on it to try and highight the issue and stop drivers from abusing the system.

Now, bosses at Singleton say it's so bad there, they've had patients missing appointments because they can't find a parking space. I find it incredible that those of us who just want to spend a few hours wandering around Swansea City centre for a few bargains, are actually preventing patients from getting the help and treatment they need. But I guess it is inevitable, given human nature, that people will try and take advantage of free parking for patients. So we clearly have to send these same people the message that it's inappropriate and they are simply disadvantaging the very individuals that everyone wants to help with this initiative - patients and their relatives.

Hopefully, installing barriers will nip this growing problem in the bud, before it gets any worse. And it is right and proper that hospitals police parking arrangements to ensure that the right people have access to the facility. Free parking is the right policy for Wales and it shouldn't be spoilt by a selfish few.

Lower alcohol limit needed to reduce deaths on our roads

The Road Safety Compliance consultation has just been released and I have to say there are several sensible ideas in it, which, if adopted, could really help improve road safety.

It’s also good to see that the Government intends to investigate the impact of drugs on driving, as well as starting a major awareness campaign on the issue. Research does suggest that illicit drugs contribute significantly to road accidents in the UK. So it’s vital we fully understand the dangers of drug driving and that police forces are given more support, to tackle the issue.

BMA Cymru Wales also supports the REMOVAL of a drunk driver’s ability to request a second alcohol test by a doctor, if they are just over the limit. Modern technology means such a requirement is now unnecessary. And, some drivers may be exploiting this, in the hope that their alcohol levels will drop as they wait for a doctor to arrive.

The BMA will continue to lobby the UK Government to reduce the current drink drive limit. The science is clear: a 50mg limit would lower the number of road crashes, deaths and serious injuries on our roads.

The introduction of the current limit, backed by police enforcement and hard-hitting media campaigns, led to a dramatic fall in the number of deaths on our roads. But it’s been stagnant since 1993. We need a new impetus, with a lower limit, to reduce the 2,946 deaths and around 30,000 injuries on Britain’s roads last year.

Let's ALL pledge to call time on binge drinking

It's great to see Welsh police forces and Church leaders in Wales coming together for the first time, to try and tackle perhaps the biggest social problem at the moment - binge drinking.

Police chiefs and the Archbishop of Wales want us to start carrying cards or sign up online, to pledge to cut down on the amount we drink.

Critics may regard it as a bit "gimmicky", but we have to really start addressing the issue and any new and novel ways of doing this, should be welcomed.

I know doctors in Wales will certainly view this as a good idea, as it's us who often see first hand the very devastating effects excessive drinking can have. It's no coincidence that Friday and Saturday nights, when the vast majority of the Welsh public go out and "have a few", are also the busiest for hospital A&E departments.

I'm not trying to preach here and be a complete killjoy, most people like to have the "odd" drink now and again, which is fine. What this campaign is focussing on, is those who don't know when enough is enough, when their behaviour starts to deteriorate and they become violent and aggressive. And that can cause all manner of problems.

Let's also not forget the financial cost here too. Surely the £70-85 million spent by the Welsh NHS on alcohol-related incidents and diseases every year would be put to better use by actually trying to save people's lives.

So before the next "big night out", maybe stop and think and sign the pledge just as I have.

Welsh Junior Doctors Committee video

Watch the Vice Chair of the BMA's Welsh Junior Doctors Committee talking about the reformation of the committee and what issues it's working on, for doctors in Wales.

Time to support some of Wales’ most vulnerable people

It’s time to address what seem to be completely inadequate mental health facilities for young offenders in Wales. Bridgend MP Madeline Moon has highlighted the issue. The lack of provision for some of society’s most vulnerable young men is so bad, they have to travel to England to get appropriate help.

One of the reasons for opening Parc Prison in Bridgend was to allow young people in Wales to carry out their sentences, as near to their families as possible, at a time when they need them most. And if the exact opposite of that is happening, then something needs to be done to remedy the situation. That’s why I back Madeline Moon’s call to set up a dedicated community mental health service at Parc. Otherwise, chances are these youngsters will go on to re-offend and will be returning to Parc prison to serve time as adults.

Wales now needs to go it alone on presumed consent organ donation

I'm really saddened to read the UK Organ Donation Taskforce's report on presumed consent for organ donation.

It also gives me a bit of a sense of deja vu, it not being so long ago since the Assembly's Health, Wellbeing and Local Government Committee rejected the idea too.

If you're a regular reader of this blog, you'll no doubt be very familiar with the BMA's stance on presumed consent, which is in favour of a soft version of it (ie anyone who does not want to donate their organs, can register their objection. Families would also be consulted to identify any unregistered objection).

This perhaps gives more weight to the argument that Wales should also go it alone, being left to decide for ourselves what organ donation system we think is best. It's all well and good different committees and organisations submitting recommendations, but ultimately it should be down to the general public to decide. Which is why we fully support the Welsh Assembly Government's series of public consultations on the issue taking place at the moment.

Let's hope it leads to an informed debate and informed decisions being made. Afterall, it is hundreds of people's lives on the organ donor register in Wales, potentially being put at stake.

Major breakthrough in fight against LCOitis

Wales is suffering from a major new epidemic - LCOitis.

The symptoms? Confusion, yawning and, in the most extreme cases, an inability to stay conscious. The source of this new and worrying epidemic - colleagues point to the appearance of the Government of Wales Act 2006 as the most possible source.

Let me explain...

Yesterday, I attended a major conference organised by the Bevan Foundation and Positif Politics. It brought together a whole host of speakers to explain how Wales is governed and how organisations like BMA Cymru Wales can make use of the Assembly's new powers. Under the Act, the Welsh Assembly Government and Assembly Members can now ask for Legislative Competence Orders (LCOs) from the UK Government -which basically means the power for the Assembly to change the law in the areas that are devolved.

Until yesterday, I was an extreme sufferer of LCOitis. Everytime an AM, MP, journalist or Welsh academic started talking about 'LCOs' my condition deteriorated.

Thankfully, I am happy to report - I'm getting better. The cure? Well, anyone who thinks they may be suffering should consult Daran Hill and Huw Edwards' excellent guide to the Government of Wales Act, available by contacting the Bevan Foundation.

So far, it's the only known cure.

Action speaks louder than words

BMA Cymru Wales’ Policy and Public Affairs team took part in a Healthy Living event at the Assembly today.

As part of the Assembly’s Healthy Living Week, key health organisations and charities from around Wales had a stand in the Senedd, all with varying themes, focusing on improving health and well-being. It was an excellent opportunity to network and to forge new alliances. BMA Cymru Wales will be meeting with a variety of other organisations over the next few weeks to talk about collaborative working on a number of important health issues.

Assembly Members including, Jeff Cuthbert, Jonathon Morgan, Jenny Randerson, Jane Hutt, Gwenda Thomas and Bethan Jenkins all spoke about the importance of becoming a healthier nation.

Such events are extremely useful, if only to put the issue in the spotlight for a few days. But that’s also where we need to start making a big difference. To stop the ever-growing obesity epidemic here, now’s the time for more than just highlighting the matter for a week. It needs to be continuous, throughout the year. And it needs to be about more than just words. A good point was made by one politician who said it will take years before we start seeing an effect on burgeoning waistlines. But by getting moving NOW, hopefully the tide will turn sooner rather later.

Reading between the lines of NHS complaints in Wales

The latest figures from the WAG show NHS complaints have increased by 11% over the last year.

Here's Chairman of BMA Welsh Council, Dr Andrew Dearden's take on the figures...

"While the number of complaints received has increased we need to see this increase in the context of the total number of patient contacts with the NHS each year. In general practice alone there is some 10-15 million consultations with patients per year and this does not include dentists, community staff and hospitals, for example. The rate of complaints therefore of just over 7,000, actually suggests a good quality, patient-friendly service.

"Of course we must not become complacent with this low rate of complaints. We strive daily to improve the service, but we must also not lose sight of the fact that millions of patients in Wales are happy with the level and standard of care they receive."

BMA Cymru Wales' new chair of Welsh Council talks about his plans for the council

Dr Andrew Dearden, a Cardiff GP, talks to BMA Cymru Wales about taking over as chair of the newly reformed Welsh Council and what he hopes to achieve during his time in charge.

We must stop cut price drink offers

I couldn't quite believe my eyes when reading this article.
£5 for 5 hours worth of alcohol I think is a ridiculous price and can only serve to encourage binge drinking. The majority of us would be able to fit in an incredible amount of drink in that time, much more than £5 worth I'm sure. To try and suggest as the manager does that bar staff are keeping "an eye" on how much customers are drinking seems rather ludicrous too. How can they do that with a club full of revellers? It also begs the question, does the offer extend to soft drinks? The answer would probably be no, so those who choose not to consume alcohol have to pay through the nose for a coke or orange juice. It's a similar situation to the one created by a leading supermarket a few weeks ago, where the price of lager was cheaper than bottled water.

But then, perhaps that's where part of the problem lies, that pubs and clubs are just trying to compete with supermarkets when it comes to offering cheap booze. That just provides customers with a double whammy though, having cut price drinks from the supermarket at home, before going out. Then drinking as much as they can for £5 in their local club. Perhaps one way to stop this would be for politicans to introduce a fairer pricing system for alcohol across the board, applying to ALL premises which serve drink.

And what about the consequences of this cut price alcohol?

BMA members (doctors) see it as first hand. It can cause family breakdowns, is a major factor in domestic violence, ruins job prospects, is often related to crime and disorderly behaviour and it kills. Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. Alcohol misuse not only costs lives it also costs the country many millions of pounds. The NHS spends millions every year on treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences.

It is for all of these reasons that the BMA continues to call for an end to such irresponsible promotional drink activities.

Organ donor public debates test opinion on presumed consent

My Policy and Public Affairs Officers attended one of the many Welsh Assembly Government public debates this week, examining the question of 'presumed consent' for organ donation.

The BMA has long-argued the need for a fundamental shake-up in the way organs are donated. We have some 500 people in Wales waiting for a donation.

What I can't quite get my head around is the fact that if you ask people, the majority will say they support organ donation. In fact, some 90% say they would be willing to donate. Unfortunately, this does not translate into people who actually sign the register - it stands at roughly 30%.

So we have a problem. The BMA believes that we need to adopt a 'soft' system of 'opt-out' or 'presumed consent'. It's a subtle difference but an important one. People would still be able to opt-out if they have a moral or religious objection but it would help those people who for, whatever reasons, do not get round to registering.

Families would also have a final say. Which is why Kidney Wales' recent "Tell a Loved One" campaign, is so important. You can sign up to the organ donor register and carry a card, but if your nearest and dearest don't know your wishes, they'll be less inclined to follow them out if you haven't discussed organ donation with them first. And as next of kin would have the final say, they could go against your wishes, if you haven't bother to tell them.

Unfortunately, there's still a great deal of mistrust from the public and I still despair when I hear people saying that this is an attempt by the 'state' or 'politicians' to 'take my organs'. I really don't think that this is the case. Doctors just want what's best for their patients, and ensuring a supply of organs that will meet current and growing demand must remain our ultimate goal.

Anyone wanting to register to be an organ donor, can do so here

Rhodri backs BMA Cymru's calls for the NHS to continue for the next 60 years and beyond

I had the pleasure of presenting a giant birthday card to the First Minister this afternoon, as the 60th anniversary of the NHS draws to a close.

The card was signed by politicians from all parties and patients across Wales, showing the depth of support for the NHS to continue as it is, free, at the point of need. This is also the perfect opportunity for the Welsh Assembly Government to send a clear a message to keep the NHS public.

Here's what Rhodri Morgan had to say on receiving the card;

"The creation of the NHS, providing free healthcare for all, is arguably the greatest achievement of any government of the 20th Century. We all owe Nye Bevan a huge debt of gratitude for having the remarkable foresight and courage to introduce the NHS in 1948.

The NHS today is a lot different from the NHS of 10 years ago, and vastly different to the NHS that Bevan founded in 1948. It has adapted and modernised, as any public service must, to meet the challenges of today and it will have to do so again to meet those of the future. There’s no doubt that the continued hard work of staff, together with investment and reform, has made a huge difference to the quality of care that patients now receive. As we celebrate its 60th anniversary, we can be proud in Wales that the founding principles that Bevan established are as dear today as they were in 1948."

It's right we have a PUBLIC debate about presumed consent for organ donation

I very much welcome the announcement from the Health Minister about a series of public meetings on presumed consent for organ donation.

BMA Cymru Wales has always consistently called for an open and honest public debate on the issues surrounding presumed consent for organ donation.

And, just as we have always argued for a shake-up of the way organs are donated, we accept that if we are going to have such a fundamental change, then the public needs to be informed and engaged about the issues. That is why we welcome this series of public meetings and we urge doctors across Wales and the general public to have their say.

Spotlight on domestic abuse

We fully support AM Nerys Evans' attempts to get the issue of domestic abuse, still very much a hidden problem, on everyone's radar. Launching a blog for victims to write about their experiences, will hopefully stop it from being so "hidden".

BMA Cymru Wales also backs Nerys' calls for the WAG to fund an awareness-raising campaign, aimed at changing people's attitudes towards violence against women. One way of helping with this would be for all doctors and health professionals to be given training in dealing with domestic abuse, which we've called for in a previous BMA report focusing on the issue.

Key recommendations from this report include:

1. All health professionals should receive training in identifying and helping patients who are victims of domestic abuse – this needs to be implemented on a national scale within emergency medicine.

2. Health professionals should ask patients appropriate questions in a sensitive and non-threatening manner, to encourage disclosure of abusive experiences.

3. Health professionals should recognise that men can also be victims of domestic abuse.

4. The government should promote a ‘zero-tolerance’ attitude to domestic abuse.

5. Refuges should be more accessible to transgender, lesbian, gay, bisexual individuals.

6. Domestic abuse education programmes should be implemented in all primary and secondary schools.

Hopefully, "humanising" domestic abuse in the form of victims blogging about their experiences, will make us all, including politcians, sit up and take notice.

Reflecting on Welsh Council's past achievements

In this video, former Chair of Welsh Council Dr Tony Calland, talks about what he feels has been achieved in his time in charge.

And in this video Dr Calland looks to the future for Welsh Council and tells BMA Cymru Wales what he thinks are the major challenges that lie ahead.

Are BMA's worst fears becoming a reality?

The ink is yet to dry on the Health Minister's announcement on the second stage consultation concerning the reorganisation of our NHS. Yet already there are jungle drums raising concerns about a potential "take over" of primary care and community care, and done deals.

BMA Cymru Wales, in its response to the first stage of the NHS Wales reform consultation, made the point that the new organisations sprouting from the reform, need to be new and fresh, to ensure balanced investment across patient services and ensure that re-focusing care into community and primary care, to free hospital services to get on with the job they are best at -becomes a reality and not an aspiration.

So what do we see this week? In North Wales, a new Director of Primary Care has been appointed, for the new combined NHS Trust of Wrexham and Glan Clwyd.

This maybe a short term appointment, it may have a rationale if hospital Trusts have been given the go ahead to take responsibility for primary care services. But I thought we were waiting for further detailed consultation on a proposed way forward. Whatever the truth of the matter, or however it has come about, it gives the impression that the new Hospital Trusts will in fact BE the newly proposed "unified organisations" - i.e. a Hospital Trust takeover. First impressions are everything I was always told!

GPs fear that primary care will become a cinderella service in any kind of "Trust takeover". We're still awaiting the full details of Edwina Hart's plans for an integrated body. If the developments in North Wales are anything to go by, could we be seeing hospital Trusts taking over? If so it has the risk of re-balancing the care, cash and power as difficult as ever.

If the WAG want to get ALL of the medical profession on board with these radical changes, we need better communication of the intention, and greater involvement with the process at the key decision making points. BMA Cymru Wales wants this one off opportunity of reform to get it right for patients and doctors. We have a unique insight into how health services work. We should have - our members are at the sharp end of service delivery every day - listen to us.

National Healthy living week

BMA Cymru Wales is teaming-up with other leading health organisations in Wales as part of this year's Health Living Week.

Encouraging people to adopt healthier lifestyles remains a massive challenge. The BMA Cymru Wales public affairs team - John Jenkins, Hayley Mellors and Chris Jones will be manning our stand at an event to be held at the Senedd on Tuesday 4th November.

If you're around, pop over and say hello.

Health under Welsh Lib Dems' spotlight

BMA Cymru Wales attends all of the main political parties conferences.

My Senior Public Affairs Officer, John Jenkins, spent last weekend at the Welsh Liberal Democrat conference in Swansea. It's nice to see that their new consultation document on health covers many of the areas that we have actively campaigned on. BMA Cymru Wales will be commenting on the specific details, shortly.
Watch this space...

Palliative care strategy launched

A major new report into palliative care services in Wales, has been published.

If the Welsh Assembly Government supports the key recommedations, services will be required to be consultant-led, with support from multi-disciplinary teams including specialist palliative care nurses and other health professionals.

Improved standards of out-of-hours care will also have to be met and a new patient registration card and single contact point will be explored to improve the support to patients and their families. This is welcome news - and long overdue.

Should we call time on cheap booze

Reports that a leading supermarket is selling cans of lager for less than the equivalent in bottled water, is nothing short of scandalous.

If true, then BMA Cymru Wales was right in calling for a series of tough new measures to limit the availability of cheap booze.

Last year, we unveiled a series of specific policy calls. These include:

A national roll-out of local schemes to outlaw the consumption of alcohol in public streets;

An increase in funding of services designed to treat alcoholism and alcohol-related illnesses;

Doctors to take a lead by helping to change both attitudes and behaviour with respect to the misuse of alcohol;

An increase in taxation on drinks containing alcohol, with taxation proportionate to the amount of alcohol in the product.

These proposals followed the publication of BMA Cymru Wales’ four point plan to tackle Wales’ alcohol problem.

The plan calls for:

A Licensing Measure to end deep discounting of alcohol for sale in off licences, supermarkets and other off sales outlets.

Research into the measures by which pricing mechanisms can be used in Wales to discourage heavy consumption of high alcohol products.

Legislate for alcohol labelling rather than relying on voluntary agreements with the drinks industry.

Reduce the drink driving limit from 80mg to 50mg and introduce random breath testing in Wales.

The BMA remains focused on offering practical solutions to Wales’ growing drink problem. This comprehensive set of measures is designed to cover a variety problem areas. It’s now up to the Assembly Government, in partnership with the UK Government, to ensure that these policies are taken forward. After smoking, alcohol is the next big public health issue.

The Government needs to get to grips with the problem.

Are we heading for a fairer funding system?

BMA Cymru Wales wants to know whether Wales gets enough money to meet its health needs.

Some politicians and academics say that the way Wales is funded is not fair. The so-called 'Barnett formula' allocates resources to Wales on population rather than a 'needs' basis. Put simply, we don't know whether we're getting the right amount of money.

I'm no financial expert, which is why I've welcomed the establishment of the Holtham Commission. I hope the Commission will allow us mere medics to obtain a very clear answer, to what seems a very simple question: Is Wales getting enough cash to meet its growing health needs?

Speed-up bowel cancer screening

News that bowel cancer screening test-kits are set to be dished-out shortly is VERY good news.

But I've never tried to hide my deep concern and frustration that the full roll-out is still some seven years away. 50 to 74 year olds in Wales will not have access to routine screening until 2015! Bowel cancer is the third biggest killer of men and women in Wales. Screening aims to detect bowel cancer at an early stage in people with no symptoms. This is when treatment is more likely to be effective.

I ask the simple question, how many people in Wales will die as a result of the delay?

The full programme needs to happen now - NOT in seven years time.

Another first for Wales!

Devolution allows us to put the concerns of some of the most vulnerable parts of society under the spot-light. First, it was children and now it's older people.

Wales is the only country in the world which has a designated Older People's Commissioner.

Last week the Older People's Commissioner, Ruth Marks, launched her first ever report. In that report she gave some indication of what is important to older people in Wales. Unsurprisingly she's found that the cost of long-term care; the lack of public transport, especially in rural areas; and a desire to be involved and be listened to, are all high on her agenda.

BMA Cymru Wales has already met with Ruth Marks and we look forward to working with her to ensure that all patients, regardless of age, get the treatment and respect they deserve.

Banning junk food from our schools

I'm glad to read that Welsh Lib Dem AM Jenny Randerson's attempt to rid schools of junk food is making progress. BMA Cymru Wales is backing calls for additional powers to improve the quality of school meals.

WAG hits back over free prescriptions 'nonsense'

I nearly choked on my Sunday morning cornflakes when I read in a London-based tabloid newspaper that the plug could be pulled on free-prescriptions in Wales. I don't know whether there is some concerted attempt to undermine the policy but it does seem that a week does not go by these days without negative and nonsense stories about free prescriptions.

That's why I'm glad that the Welsh Assembly Government has issued such a robust response to this 'nonsense'.

A story in yesterday's News of the World - claiming that Wales is about to end free NHS prescriptions - is absolute nonsense! The Welsh Assembly Government told the News of the World on Friday that there was absolutely no intention of 'pulling the plug' on our free prescription scheme.

The scheme is a long term investment in managing chronic conditions and improving health will ultimately reduce the cost and pressure on the NHS. The scheme is highly popular, and we are delighted that Scotland and Northern Ireland are following our lead. We're at a loss to understand where this story in the News of the World has come from.

BMA Cymru Wales response to Health Minister's statement on NHS reorganisation

BMA Welsh Secretary Dr Richard Lewis said: "We welcome the Minister's statement but are concerned that it raises more questions than actual answers. We need greater detail and clarification from the Minister and time to consult fully with our members in order to be in a position to give a detailed response to todays statement."

On the National Advisory board

"BMA Cymru Wales offers a cautious welcome. BMA Cymru Wales would much rather a fully arms-length approach, however at least with this arrangement the buck will stop firmly with the Minister, of which there can be no doubt."

On a separate Delivery Board

"It would be inadvisable for any Minister not to ensure that frontline clinicians and professional organisations like the BMA are fully represented. The NHS and patients rely on the support of doctors for delivery of care, and we seek a categoric assurance from the Minister our representation is assured."

On primary care

"We welcome the Minister's commitment to pursue a health service led by preventative, primary and community health services. The vice-chairs of the new organisations who will be made responsible for community, primary and mental health services appears to be a creative solution. Of course, we await the detailed work to be undertaken by Dr Chris Jones, chair of the RCT LHB who's been charged with development of a new primary and community health care strategy."

On the 7 new health bodies

"We await the exact details. Whilst the detail remains unavailable it puts into question the ability of the Minister to deliver these changes by April 2009. We need to get these changes right."
On a Unified Public Health organisation.

"BMA Cymru Wales welcomes the creation of a Unified Public Health organisation with executive responsibility for public health being vested with the seven NHS Local Bodies and at a national level. This will ensure a powerful voice to the National Health - as well as continued partnerships with local government.

"We believe that the local Director of Public Health position is of paramount importance in planning health services on the basis of need and also in assuring the protection of the health of the public - in line with the duties of the NHS.

"However, the BMA seeks urgent clarification as to the content and constitution of the new public health body and more importantly that it will remain part of the NHS."

BMA Cymru Wales backs call for all-Wales Tobacco strategy

Last week, I joined other members of the Welsh Tobacco Control Alliance (WTCA) in calling on the Welsh Assembly Government to develop and implement a comprehensive Tobacco Control Strategy for Wales.

The launch took place at the National Assembly - with First Minister, Rhodri Morgan and Grand Slam winner and Junior doctor, Jamie Roberts doing the official honours.

The WTCA is calling for additional measures to strengthen community action for tobacco control, ensure access for all smokers to effective and equitable cessation services and products, encourage people to go smoke free in their own homes, and for greater investment in training, research and monitoring.

Current members of the WTCA are:
ASH Wales
British Heart Foundation
BMA Cymru Wales
British Lung Foundation Cymru
Cancer Research UK
Diabetes UK Cymru
Royal Pharmaceutical Society of Great Britain (Wales)
The Stoke Association (Wales)
Tenovus
Firebrake Wales
Community Housing Cymru
Cardiff University
Children in Wales
All Wales Ethnic Minority Association
Royal College of Nursing
Asthma UK

Finally - a warm welcome for free prescriptions!

There's been a great deal of discussion on this blog about the policy of free prescriptions. Northern Ireland’s Health Minister's now announced they are following Wales’ lead and abolishing all charges by 2010.

For those doubters, it might be worth reading some of the following quotes. I couldn’t agree more …

MICHAEL McGIMPSEY, HEALTH MINISTER - "A cradle-to-grave health service, free at the point of delivery, is the founding principle of the NHS, which was founded 60 years ago this year. It is a principle that I, and the entire population of Northern Ireland, wholeheartedly support."

IRIS ROBINSON, HEALTH COMMITTEE CHAIRPERSON - "I and many of my colleagues have encountered constituents who are sometimes placed in the sad position of choosing to pay for fuel to heat their homes or drugs to help their health. No person in 21st century Northern Ireland should ever be placed in such a position."

Dr BRIAN DUNN, BRITISH MEDICAL ASSOCIATION - "This is a very positive step forward and all those patients in Northern Ireland who have found it very hard over the years to pay for their medication will welcome it - as does the BMA. It has been the association's policy, since 2002, that prescriptions should be free to everyone."

HEATHER MONTEVERDE, MACMILLAN CANCER SUPPORT - "Macmillan has been campaigning to have prescription charges for cancer patients abolished for a number of years. We are delighted the minister has listened to us and to all those who demanded free prescriptions."

MICHELLE O NEILL, SINN FÉIN HEALTH SPOKESPERSON - "This move is long overdue and will make the burden of those suffering illness a lot lighter. Sinn Féin had launched a campaign over a year ago to see that inequalities in health provision were removed and we support the Minister in the delivery of this project."

CARMEL HANNA, SDLP HEALTH SPOKESPERSON - "There was always something very wrong with having a tax on the sick. Unfortunately for many people they simply couldn't afford the high prescription charges for necessary drugs and so went without."

KIERAN MCCARTHY, ALLIANCE HEALTH SPOKESPERSON - "This move means that people who struggle to pay for important medicine to combat cancer and other long-term illnesses can now have some small element of peace of mind in future. "

PATRICIA GORDON, MS SOCIETY OF NORTHERN IRELAND - "The MS Society has lobbied the minister for health on a number of occasions around this issue and he has proven himself to be a man of his word. When we met him earlier this year on the issue he promised to do all that he could and this announcement is a real boost to ordinary people who have MS across Northern Ireland."

Disorganised reorganisation?

I couldn't agree more with the views of Welsh Conservative Health spokesperson and Chair of the Assembly's Health Committee, Jonathan Morgan about proposed structural changes to NHS Wales.

We were told by the Minister that the second-stage consultation would be published in the Autumn. It's nearly October and we still don't have it. As for these changes being in place by April 2009. That seems far too optimistic as every new day passes.

BMA Cymru Wales has been very clear, structural changes must result in better services for patients and more resources targetted at frontline services. We believe that in order to achieve these ambitions doctors need to be involved in the discussion on these reforms at the highest level.

We await Edwina Hart's statement with interest ...

So are the Tories now set to scrap free prescriptions and hospital parking?

Today's Western Mail reports that the Welsh Conservatives consider free prescriptions and hospital car parking 'reckless'. It begs the question - would a Welsh Conservative Assembly Government therefore scrap them?

Nick Bourne is expected to tell the Conservative Party conference in Birmingham that the Welsh Assembly Government is wasting too much of the Assembly's £15bn budget on 'freebies'.
Whilst I am all for saving finite Assembly resources, the £30m set aside for free prescriptions is just a pin-prick in the total £15bn budget. I suppose it boils down to political priorities - I understand that, but speaking as a health professional, I know that patients are now getting the medicines they need and that the stress and financial burden of paying to see sick relatives whilst in hospital has been removed.

But what really annoys me is the suggestion that patients campaigning for the latest and expensive drugs would get them if free prescriptions were scrapped. The reality is that the cost of the latest wonder drugs are set to continue with even more pressure piled on decreasing budgets.

Rather than the posturing we get from politicians perhaps there is a need for the medical profession, politicians and patients to sit down and have an open and honest discussion about what the NHS can and cannot deliver?

Hollywood stars paid a small fortune to “light up” the big screen

It probably comes as little surprise to most of us to discover that film stars of the 1930s and 40s were paid vast sums of money, to promote smoking and particular brands of cigarettes. Apparently, one tobacco firm paid more than $3m in today's money in one year, to stars like Clark Gable, Cary Grant, Spencer Tracy, Joan Crawford, John Wayne, Bette Davis and Betty Grable.

Of course, back then, the health risks now associated with smoking weren’t really known and with such celebrity endorsements it was the “done thing” to be seen with a cigarette in hand.

Perhaps the surprising finding from this research is the fact that today, despite all the warnings that “smoking kills”, characters smoking in films can still influence young people to take up the deadly habit. It was for this very reason that the BMA released its “Forever Cool” report earlier this year, calling on film censors to take pro-smoking content into account when classifying films.

And it’s not just the big screen where youngsters can see famous faces lighting up. It’s closer to home too, on the small screen, in their living room. There are still many characters in popular soaps such as Coronation Street (Liz McDonald, Deirdre Barlow, Lloyd Mullaney) and Eastenders (Pat Butcher), who can seen smoking, it being part of their everyday life. These shows are on way before the watershed and are instantly accessible to teenagers. That’s why, as part of our “Forever Cool” report the BMA’s called for the following;

• The UK Governments should implement educational programmes aimed at informing those involved in the production of entertainment media of the potential damage done by the depiction of smoking.
• The British Board of Film Classification should take pro-smoking content into consideration for the classifications of films, videos and digital material in the UK. This should consider whether the depiction of smoking is condoned, encouraged or glamorised in the absence of editorial justification.
• All films and television programmes which portray positive images of smoking should be preceded by an anti-smoking advertisement.
• The UK Governments should implement a sustained population-wide communications programme promoting anti-smoking messages and imagery.
• The UK Governments should develop a tobacco control strategy with the aim of making the UK tobacco-free by 2035.

And while on the subject of smoking, BMA Cymru Wales welcomes the imminent move to place graphic images on cigarette packets. The written warnings have been around for 5 years now and as such, their impact will have decreased over time. Also, simply reading about the potential harm smoking can have, isn’t always a strong enough deterrent. But actually being able to see it, may make the message hit home that much harder, particularly with young people, who may think twice before emulating their screen idols.

GPs work extra hours for their patients

This week's announcement on extended opening hours for GP surgeries is good news for patients and profession alike.

For months GPC Wales – the body that discusses these issues with the Welsh Assembly Government on behalf of the profession – has been discussing how best to serve our patients.
GPs' surgeries in Wales will now able to open in the evening and at weekends in return for extra funding. Because for all the anti-GP nonsense that has been dished-out recently, on the whole, GPs accept that for some it is difficult to attend appointments during working-hours.

But this announcement is more than just about hours. The deal includes a new "menu" of enhanced services for people with diabetes, the homeless, asylum seekers and refugees and for care home residents.

Devolution is a developing process but as Dr David Bailey, the chairman of the GPC Wales, says the consultation and collaboration between doctors and the Welsh Assembly Government on this issue is far more constructive than the gun-against-the-head, take-it-or-leave-it option presented to GP colleagues in England.

GPs will actually be getting a better service in Wales because the Welsh Assembly Government has been reasonable, focused and committed to working with the profession, in trying to deliver a service which is as close as possible to what GPs deliver in the normal working day.

It just goes to show that BMA Cymru Wales has been saying for some time - many of the answers to the vexed questions of how to deliver healthcare services lies with doctors.
The challenge to politicians is to work with and trust the profession to assist in identifying the answers.

Waiting on waiting times

Looking at the latest NHS Wales waiting times, makes for worrying reading. There is quite clearly a rise in the number of patients waiting in these target areas. As such we would be extremely about the Welsh Assembly Government's ability to meet the two deadlines set for March 2009;


Reducing the maximum waiting time for inpatient or day case treatment to 14 weeks.


Reducing the maximum waiting time for a first outpatient appointment to 10 weeks.


If you also take into account the fact Winter is approaching, bringing with it the usual seasonal rise in emergency admissions, meeting these targets looks even less likely.

Gordon wows the English - but what about the Welsh?

Listening to Gordon Brown's Labour party conference speech you could be forgiven for thinking he has no knowledge of Welsh health policy.

Take for example, his announcement on prescription charges. He's announced that cancer patients and people with long-term conditions will get free prescriptions. An excellent move, but one that's already happening in Wales.

Or universal check-ups for patients over 40. Does this apply to Wales and if so, who will do the work?

Also, what about his pledge that the majority of GP surgeries will be open on weekends. Does this apply to Wales and, if it does, has he shared this with our Health Minister, Edwina Hart, and the Welsh GPs who will be expected to open their doors?

In reality, Gordon Brown was talking to an 'English' audience but major 'English' health announcements, like this, only help to confuse Welsh clinicians and patients alike. I know from my own experience that Welsh GPs will sit down and will be asked about weekend opening hours or when patients will get their check-up.

When it comes to health, devolution allows Wales to do things differently - a fact which appears lost on our Prime Minister - or at least his conference speechwriters! With the vast majority of the Welsh population still reliant on 'national' TV, radio and newspapers for their 'news' this confusion over health policy is something that looks set to continue.

Cautious commendation for Rhondda MP's health check

Rhondda MP Chris Bryant should be congratulated for getting-out of the Westminster bubble and spending time with the dedicated and hard-working medical professionals that serve his constituents.

Like Chris Bryant, BMA Cymru Wales has called for a ‘revolution’ in primary care. We agree there’s a desperate need for resources to be pumped into GP surgeries and for a major awareness campaign to educate patients on how best to access NHS services.

However, some of Chris Bryant’s comments regarding GP clinics need greater scrutiny and discussion. Yes - salaried GPs have a role in meeting shortfalls in places like the Rhondda - but whether they are the golden bullet to help solve all of primary care’s problems, we are yet to be convinced.

Politicians might also do well to reflect on the reasons why the UK Government supported GPs giving up responsibility for their patients outside of normal working hours.

The increasing feminisation of the workforce, matched by the desire for greater work-life balance was intended to make the job as a GP a more attractive option, at a time when general practice was becoming an increasingly unpopular choice. More importantly, it ensured that GPs weren’t carrying out consultations and making decisions on potentially life-saving matters, with just a few hours sleep.

Finally, whether patients have to take a day-off work to see their doctor is also worthy of greater discussion. Rather than focus on extended hours, perhaps we should be asking why employers make it difficult for their employees to take time off to see their doctor and whether their duty of care should include the health of their workforce.

However, one thing that is clear is that politicians and clinicians want to see NHS Wales deliver the best possible care for our respective constituents. Perhaps if all politicians took the time and effort to engage directly with clinicians, like Chris Bryant, we would end up with policies that suit politicians, clinicians and more importantly the Welsh public.

Presumed consent for organ donation back on track?

Last month, I blogged on how disappointed I was that the Assembly's Health Committee had rejected calls to introduce presumed consent for organ donation.

That's why I am delighted by today's news.

The Welsh Assembly Government, like the BMA, disagrees with the Committee and says that we should have the power to introduce presumed consent. The Health Minister, Edwina Hart had already made her personal views very clear that she supports presumed consent.

Given the Welsh Assembly's positive intervention it's clear that BMA Cymru Wales, Kidney Wales and the many other campaigners must now keep-up the pressure, muster public support and finally get the powers that Wales needs to save even more Welsh lives.

Welsh Lib Dems call for free prescriptions and hospital parking to be scrapped

Free prescriptions and hospital car parking in Wales, could be scrapped under new plans unveiled at the Liberal Democrat’s conference yesterday.

The party’s health spokesperson, Jenny Randerson AM, has announced a range of new policy ideas which include getting rid of two of the Welsh Assembly Government’s flagship policies.

It quickly follows last week’s controversial call by the Welsh Liberal Democrats for more private money in the NHS.

Thankfully, the proposals rule-out the use of the Private Finance Initiative (PFI) to build new hospitals and for private clinics carrying out NHS operations, which the BMA warmly welcomes.

However, the policies raise more questions than answers.

Scrapping free prescriptions and hospital car parking charges are a mere smokescreen. If any politician genuinely believes that patients’ are missing out on the latest wonder drugs in the NHS as a result of these policies then, I’m sorry, they are wrong.

If politicians are serious about solving the dilemma of how patients should access the latest and expensive treatments and drugs then they need to be honest with themselves and engage in an open debate with the public about what the NHS CAN and CAN'T deliver.

The same goes for the use of private money. Any private investment in NHS Wales would surely come at a price. Can you honestly see any private investor or company investing in NHS Wales for purely altruistic reasons? Of course not, they’re in business to make money and not to treat patients.

So, I ask the simple question - what is wrong with a NHS free-at-the point of need, funded through general taxation? Perhaps all politicians, when considering new policies, would do well to reflect on these founding principles.

Salaried GPs Vs self employed GPs

And while I'm on the subject of the Welsh Lib Dems, at their UK conference this week, they've raised the issue of salaried GPs. In their discussion paper on health, the Lib Dems are looking at putting GPs on salaries, rather than the current situation of doctors being their own employers, and being partners in GP practices.

But, if the party looked at this in a little more detail, they would know that many doctors here are already employed as salaried GPs, by practices, Local Health Boards or out-of-hours providers.

One of the reasons the Lib Dems are looking at this is because salaried GPs are often thought to be the cheaper option. Yet, there are still costs attached. If self employed GPs were replaced by salaried ones, the cost of running a practice and all the individual businesses involved would still have to be met by someone.

That "someone" would have to pick up the tab for the following;

1. 100% of the practice staff wages bill.

2. All the practice staff costs.

3. Salaried doctors would expect full entitlement to sick pay, study leave, etc.

4. All the ordering of practice supplies.

5. Rental charges, or else buy the practice premises and incur all the costs of running it.

6. Salaried doctors would expect to work within European working time directives.

7. Salaried doctors would expect 10-15 minutes per appointment.

8. Meet BMA locum costs whilst the salaried GP is on trade union business.

9. Picking up the salaried doctor's superannuation.

10. Change GMS regulations to take the current contract away, as it is now a rolling contract.

This is by no means an exhaustive list, but gives a flavour of just what would be involved and the significant costs attached to putting our GPs on salaries. Maybe not as easy and cost-effective as the Lib Dems first thought?

Light at the end of the tanning tunnel?

It's only a few days ago since I posted on here about the dangers of using sunbeds, citing the example of Zara Hovelsas. She's addicted to sunbeds, despite having had skin cancer and knowing using them, could eventually kill her.

I also pointed out the heavy campaigning work BMA Cymru Wales has undertaken to try and get tighter restrictions on the use of sunbeds.

So I'm absolutely delighted that the Welsh Health Minister has raised the matter of regulating the industry with the Department for Health in England. (WAG doesn't have power to legislate in this area).

Not only that, the Welsh Assembly Government's commissioning a study in Wales to estimate how much sunbeds are being used by young people.

Maybe we'll finally get the legislation we've been fighting for, it is certainly a step in the right direction anyway.

Shabby way to treat England's newly qualified junior doctors

I whole-heartedly support my English BMA colleagues attack on the Westminster Government's "shameful"refusal to even hold talks about the axing of accommodation support to newly qualified junior doctors. The BMA wrote to Anne Keen, England's Health Minister, back in July to request a meeting about the move to end the legal requirement for NHS trusts to provide free hospital accommodation to first year junior doctors. (At an estimated annual cost of £4,800).

Thousands of freshly qualified junior doctors who began work in August will just be starting to feel the effect of this, facing their first rent payments around now. That's on top of an average debt of £21,000.Even though the BMA has outlined the financial implications of this, Anne Keen refuses to meet with my English counterparts.

Thankfully, BMA Cymru Wales' campaign on this issue has already seen the Welsh Assembly Government guarantee free hospital accommodation for newly qualified junior doctors, until next Summer. Also, the Health Minister, Edwina Hart has established a working group to review staff accommodation across all hospitals in Wales - with respect to standards - which in some hospitals is appalling - to the extent that it should be freely provided.

I sincerely hope in coming up with recommendations, the group takes account of the fact Wales needs to do all it can to ensure junior doctors are attracted to work in Wales, and spend their future career here. While only one piece of the jigsaw in that issue - free accommodation will be one of the factors that influence whether the Health Service and the patients of Wales have the numbers of junior doctors we need, or will be running with disrupted and less than adequate services - as seen with the recent problems at Singleton Accident and Emergency Department.

As good as it is, free accommodation guaranteed until August 2009 is unlikely to be good enough to avoid these risks. And for any prospective junior doctor reading this, rest assured, BMA Cymru Wales will be doing all it can to try and get this message across and encourage the Welsh Assembly Government to continue to support junior doctors as it is doing now, and extend the agreement beyond next year.

Ban the tan?

Warnings and horror stories about the use of sunbeds seem to be in the news every other week these days. The vast majority of us are aware of the potential damage we could be doing to our health by using them.

These include:

Developing certain types of skin cancer – the risks appear to be greatest for the young, with the chances of developing a tumour increasing by up to 20% per decade of sunbed use before the age of 56.

Premature ageing – people tend to use sunbeds to look better but they could end up with leathery, wrinkled and sagging skin.

The eyes (in particular the cornea) are very prone to damage from tanning equipment – it is recommended that sunbed users wear protective goggles, but research shows that people may not use them even if they are provided.

The immune system – increasing evidence shows that sunbeds have an immunosuppressive effect.

Even using sunbeds just once a month is enough to double your annual dose of ultraviolet (UV) radiation. The risk of skin cancer is related to lifetime exposure to UV light, and intense exposure is the most dangerous.

So, I was shocked and dismayed to come across the story of Zara Hovelsas who admits being addicted to sunbeds, despite having had skin cancer and knowing using them, could eventually kill her.

The regulation of sunbeds is something BMA Cymru Wales has been calling for, for sometime now.

We want a bill brought in which would require sunbed operators to have a licence from the local authority.

The would also cover the following:

Prevent children using sunbeds

Protect adults from over-exposure

Ensure sunbed users are supervised

End the use of coin-operated machines

Ensure sessions are monitored and limited

Provide health risk information in parlours

Ensure premises are inspected

Maybe this would go some way to stop other people getting addicted, like Zara Hovelsas.

Making sure the doctor's bible is accessible to all

Flicking through the new edition of the BNF (British National Formulary) has got me thinking just how vital a reference tool it is to the medical profession, not least to those just starting out.

It really is a doctor's "bible", containing all the latest prescribing advice. I remember how I used to carry my own somewhat dog-eared copy around with me as if it were some kind of rare gem. But then, not so long ago, the BNF did become a little like gold-dust, with talk of it being rationed and with some GPs telling me they had only one copy per surgery. Not terribly useful if you need to use it and it's in another consultation room.

I do have it on good authority however that this situation has since been remedied and that now, whoever in the medical profession wants a copy of the BNF, can get access to one.

And this leads me on to a prescribing matter of a different kind - the issue surrounding the regulation of dispensing in Wales. This has the potential to significantly disadvantage and inconvenience patients.

I know rural health matters are a priority for the Welsh Assembly Government. So I find it astonishing that in approaches to them via the BMA's GP committee, this "loophole" has not been acted upon. The committee has urged the Welsh Assembly Government to bring regulations here, in line with England and protect surgery dispensing services that are so essential to rural communities and valued by patients in these areas. How long will this situation be allowed to continue?

We can't bury our heads in the sand over organ donation

I can understand where Denise Robertson is coming from here, after all, we Brits are well known for our stiff upper lip and not wanting to discuss such issues as death. But at the same time, is that a good enough excuse to stop us saving potentially hundreds of people's lives on the transplant waiting list?

Not so long ago this very issue was on the Welsh political agenda, with the Assembly's Health Committee rejection of the idea of introducing presumed consent for organ donation, in the near future. The reason for the rejection - the committee did not believe that it is currently the most urgent priority and would act as a “distraction”.

BMA Cymru Wales has campaigned for presumed consent for organ donation for some time now.
There is little doubt that a system of presumed consent would produce a far higher potential donor rate than at present, which is far too low at 22%. Experience of other European countries that have introduced presumed consent have demonstrated this. Some 400 people in Wales are still waiting for transplants and one person dies each day in the UK, waiting. The committee has missed an opportunity to shorten the delay for those people waiting desperately for a transplant.


As Denise Robertson herself points out "Every year almost 1,000 people die, either while on the waiting list, or having become so ill they are no longer able to withstand transplant surgery. Each one of us could save a life, maybe more than one, by signing a donor form now and giving away something that one day we will have no use for. We could discuss it with those we love and encourage them to see it as a renewal and not a loss. "

I couldn't have put it better myself, so let's start having a frank and open discussion with our loved ones about presumed consent, however difficult that maybe. Surely it can't be any more difficult than the long and anxious wait for people on the organ donor transplant list?

You can register online for organ donation and the UK Transplant website also gives a lot of useful information to help you decide and to use in discussions with loved ones. As I've already said, it is so important we involve our family, friends and loved ones in our decision - as they would be the ones left to ensure our wishes are met - which is never easy - so we all owe it to them to make sure they are involved in such an important decision.

Jenny Randerson responds...

This is an email I've received from Jenny Randerson, Cardiff Central, Liberal Democrat AM, re. my post on Monday.

"Thank you for giving me the opportunity to respond.

You will be aware I am sure, of how often small parts of much longer interviews are taken out of context, and this is exactly what David Williamson has done in this article. He phoned me about two separate issues and for some reason spliced the quotes together into one.

Let me get two things straight, firstly, I do not like the blanket PFI model, and secondly, I did not mention private finance in the context of any plans that I may or may not have to stand for the leadership. Instead, after that discussion, he asked me for my views on private finance and I pointed out to him the upcoming health committee report into PFI.

I told him that it would make some very interesting reading and stated that I believe that pragmatically speaking, because of the Westminster model for funding capital developments, we must find ways to unlock Private Finance in the NHS providing that it does not interfere with the fundamental principles of the NHS. All I said was that I am not in favour of the blanket ban on private money and believe that examples such as the mutual model can harness private sector money for use within the NHS.

In an Ideal world, I would like to say there should be no private money in the NHS but the fact of the matter is that Gordon Brown provides Wales with capital finance on the understanding that we use private sector money to top it up. As a result of the fact we are not doing this, capital projects in the NHS in Wales are falling further and further behind Scotland, England and Northern Ireland. We cannot allow this to continue.

I hope that this helps to clear up the situation and the misinterpretation which I blame on bad journalism rather than you."

Don’t be selfish by abusing free hospital parking

As mentioned in my blog here last month, BMA Cymru Wales fully supported the Welsh Assembly Government’s decision on scrapping hospital parking charges, something we felt for some time was merely a tax on the sick.

So I was very dismayed and concerned to read about how a minority of people are abusing the system. It seems some of us are parking in hospital grounds to go shopping for instance, instead of using an NCP, where you would have to pay. This of course is not what free hospital parking was intended for, to help those who’re ill and needing treatment.

The fact that hospitals feel the need to introduce fines means this abuse of the system is becoming more and more widespread. And is a sad indictment of the society we now live in, when those who GENUINELY need to park within hospital grounds can’t do so because of a selfish few. We need to make sure patients and relatives of those who are sick are the ones that actually gain from this, not someone going for a browse around the sales. Although the policing of hospital parking is necessary, surely it’s far better we weed out those who abuse the system, rather than penalising everyone and in particular, those people who can ill afford it?