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?

The role of the doctor...

...seems to be being undermined once again.

This time the issue is being debated in the British Medical Journal.

Bonnie Sibbald, Professor of health services research at the University of Manchester argues that nurses can deliver as high quality care as GPs in most areas of general practice including preventive health care, the management of long term conditions, and first contact care for people with minor illness. And as such, should be the frontline providers of primary care, taking the place of GPs as the first point of patient contact.

But, thankfully, we do have, in Dr Rhona Knight, a GP from Leicester and who has first hand experience in a nurse led practice, someone to fight the corner of doctors. Dr Knight quite rightly points out that nurse led primary care would restrict patient choice and undermine the importance of nurses’ unique contribution to primary health care.

We must remember that GPs' shouldn't and can't be subsituted, with Dr Knight highlighting the difference in training for doctors and nurses. To become a general practioner, it takes 10 years and once qualified, they become hugely experienced in dealing with undifferentiated illness which enables them to be key deliverers and leaders of generalist healthcare. In contrast, she says, advanced nurse training is less developed and recommends a minimum of only 500 indirect or direct supervised hours and the competencies cover "just nine pages".

The erosion of the role of the doctor in some areas is something the BMA's annual meeting this year thoroughly condemned and must be resisted - let's get it straight, if someone wants to take on the role of a doctor - then bite the bullet and go and train as one.

Would the Welsh NHS be safe in the hands of the Lib Dems?

Having read this article , I feel Jenny Randerson needs to clarify her call for greater use of private finance in the NHS.

The Cardiff Central Liberal Democrat AM and party's Health spokesperson is quoted as saying that if she was to stand as the next leader of the Welsh Lib Dems, then her party should consider how best to use private sector finance to improve the NHS.

The One Wales government has many faults, but at least one positive thing that they've done is to rule out the use of the private sector in the NHS and the use of private finance through PFI projects.

To me, it seems Jenny Randerson's comments are at adds with this and appear to contradict her party's previous statements on the use of the private sector in the running of our NHS. You only have to look over the border to England to see the danger to the public service ethos of our NHS if we are to seek greater use of private sector funding.


If Jenny Randerson seeks to one day lead her party and potentially become the next First Minister, we need to know just what she has planned.

Where Wales leads, others follow?

So the government in Scotland has decided to fall in line with Wales, by scrapping hospital parking charges.

This is great news and should be commended. BMA Cymru Wales campaigned long and hard on the issue here, with the Welsh Health Minister eventually abolishing what we believe is simply a "tax on the sick". That came in to effect here in April (hospitals with private contracts have been told to gradually phase these out).

Why should people who're ill, or with relatives who are, have to indirectly pay for treatment, which is, under the founding principles of the NHS, meant to be "free at the point of delivery".

It will be interesting to see now what happens in England and Northern Ireland.