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.