Seasons Greetings

I would like to wish all our members and regular observers of my blog a very merry Christmas and a happy new year.

2010 will inevitably bring with it huge challenges to the NHS in Wales, particularly in the light of financial uncertainty and real cuts in funding of public services. However, whatever the New Year brings you can rest assured that BMA Cymru will continue to be at the forefront of discussions, striving to improve the health of the people of Wales by representing the doctors who care for them. We believe doctors in Wales can provide the medical leadership needed to ensure NHS Wales delivers the services that will improve outcomes for our patients. While service delivery is important, so too is the training of the doctors of the future; one cannot be sacrificed for the other if we are truly to create sustainable excellence in healthcare attracting and retaining the very best doctors to Wales.

BMA Cymru looks forward to working hard on behalf of its members in 2010, and sends Seasons Greetings to all - especially those working for our patients over the holiday period.

Presumed consent: the debate

Fervent debate has followed the announcement by Health Minister Edwina Hart last Friday that Wales could move to a system of presumed consent for organ donation.

Jonathan Morgan AM has voiced his concern over the announcement. This is what I said in response:

“We recognise that the introduction of an opt-out system would be a controversial decision, and as such those who do not want to donate their organs will sign up to opt out. A law on presumed consent would, at a single stroke, save lives whilst still giving the individual the right to have a choice.

“Given the very high level of support for organ donation expressed in repeated surveys it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not.
“Presuming consent rather than presuming objection is more likely to achieve the aim of respecting the wishes of the deceased person.

“We believe that with further debate and information about the way such a system would operate, there will be widespread public and professional support for such a change.

“The gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

“We must recognise that the current system is unable to meet the increasing demands placed upon it. Steps must be taken to increase the availability of organs for transplantation.

“Let’s show that we still care deeply about the health of our nation and that we are willing to lead with bold initiatives whilst other countries dither and waver.”

I’m looking forward to hearing Jonathan’s response.

We will continue our work with the Welsh Assembly Government and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option. You can expect to hear a lot more from us on this important issue.

What are your views on the announcement?

Organ Donation in Wales

BMA Cymru Wales is delighted with the announcement that the WAG will explore the possibility of introducing a soft opt out system for organ donation in Wales, and that a bid for a Legislative Competence Order will be submitted.

I hope that this brave decision by the Health Minister will mark a small step towards ending the tragedy of patients dying while waiting for a transplant.

Organ transplantation saves lives and it can transform the lives of people suffering disability and the tremendous burden of dialysis. There have been many high profile cases highlighted by the media over the last few years which touched us all.

As long ago as 2000, doctors voted for an opt-out/presumed consent scheme to be introduced in the UK following its success on the continent which increased the number of organs available for transplants and therefore reduced the number of patients who die waiting for a transplant. They also agreed that a public education campaign about the merits of organ donation should take place before introducing the scheme.

BMA Cymru Wales will continue to work with the Welsh Assembly Government, Kidney Wales, and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option.

Tell us what you think of the announcement.

Responsible drinking

As pubs and clubs are gearing up for one of the busiest nights of the year - widely known as “Black Friday”, BMA Cymru are urging party goers to drink responsibly tonight.

Black Friday has become one of the busiest nights of the year for those working in Hospitals and the emergency services in Wales. Hospitals are busy putting extensive contingency plans in place to cope with an influx of alcohol induced injuries.

The combination of the Friday before Christmas, pay-day and binge drinking will put an increased strain on services in Wales.

Anti-social behaviour, violence, and drink-driving will multiply this weekend across Wales due to an increased level of alcohol intake, and in many cases, binge drinking.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. I've said it before - we are not looking to restrict people from having a choice about consuming alcohol, we just want to encourage adults to drink in moderation, rather than drinking to get drunk.

Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking.

It is vital that people make alternative arrangements for getting home if they are drinking this weekend. Even driving the morning after can be dangerous as alcohol may still be in the system.

I met with Kate Edwards and Melanie Hamer of Pontypridd Women’s Aid recently who have considerable experience in supporting and dealing with victims of domestic violence. They were extremely concerned that the number of complaints about domestic violence would increase this weekend. Kate Edwards who is the Chair of Pontypridd Women’s Aid said:

“There will be a visible police presence out on the streets prompting some to take their anger out at home.

“It is particularly sad when such incidents occur at a time which is meant to be a happy one. Domestic violence can have a dreadful effect not just on the victim, but of course on the children and it can end up not just ruining their Christmas, but impacting adversely on the rest of their lives.”

So the message from us at BMA Cymru is – enjoy a drink, but don’t overdo it.

BMA Cymru support Julie Morgan MP's private members bill

Julie Morgan, MP for Cardiff North has put down a private members bill which would ban under 18’s from using sunbeds, and ensure all sunbed use in England and Wales would be supervised.

BMA Cymru are delighted that Julie has chosen to use her bill to close a loophole in law to protect the public – particularly young people – from the dangers of sunbeds and from over-exposure to intense UV radiation.

This is something we have campaigned heavily on this year in Wales - calling for tighter regulation of the commercial sunbed industry; particularly for a ban on coin-operated / unsupervised salons and a ban on the use by under 18s.

The link between exposure to UV radiation and skin cancer is now indisputable – shown by the recent decision by the International Agency for Research on Cancer to raise the sunbed classification to “carcinogenic to humans” - the highest risk category.

Just one session a month on a sunbed doubles the average individual's annual dose of UV radiation and this is proven to greatly increase the risk of cancer, skin and eye problems in later life.

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

There are no formal guidelines about standards of private sector tanning salons, the ones which do exist are only advisory and providers are free to ignore them. Anyone can decide to set up a tanning salon, and they need no training or qualifications.

In 2009, there is no excuse for such lax regulation. When we gave evidence to the National Assembly for Wale’s Health Committee inquiry a few months ago that is exactly what we said – we are delighted that the Committee took our recommendations forward, and now we are even more delighted that Julie Morgan MPs Private Members Bill could close this gap in public protection on a UK level for good. We will do everything we can to support her.

The bill has it’s second reading on 29 January 2010 – we will be watching closely.

Tell us what you think of this private members bill.

Our booze culture

The Western Mail has reported today that the number of people admitted to hospital with alcohol-related conditions has risen by 30% in five years.

These figures are unsettling. The population is drinking more and our society is awash with pro-alcohol messaging, marketing and behaviour.

Over the festive period, the admissions to A&E for alcohol misuse will put a huge strain on NHS resources. Intoxicated patients are dealt with by a variety of medical staff and even security guards if they are violent and abusive. Added to this are the costs of tests and treatment, and if the patient is then sent to a hospital bed on a ward, the costs mount up even further.

Supermarkets offering cut price deals and drinks promotions in pubs and clubs exacerbate the problem as people indulge over this period. All these promotional activities serve to normalise alcohol as an essential part of every day life. It is no surprise that young people are drawn to alcohol - when it is cheaper than bottled water, we have to worry about what message we are sending our children.

Alcohol misuse causes family breakdowns, is a major factor in domestic violence, is often related to crime and disorderly behaviour and it kills. It is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The public should be made aware of the serious risks associated with drinking, so that they can make informed decisions about how much alcohol they are consuming.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. But the growing booze culture is creating serious problems for the future. Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking. We would like to see people enjoying alcohol sensibly without over doing it.

Are you a healthcare professional who has dealt with patients who have been admitted due to alcohol misuse? Share your experiences with us.

Action on aggressive behaviour in A&E

I am pleased that the pilot to install CCTV in 4 A&E departments in Wales is being rolled out today and if successful, will be extended across Wales.

The Minister is clearly taking action on the violence and aggressive behaviour agenda.

BMA Cymru have repeatedly stated that there should be zero tolerance to violence of any sort in the NHS and the mechanisms must be there to minimise the likelihood of attacks, to support staff who experience them, and to ensure that anyone who commits an act of violence is dealt with appropriately.

Hopefully these cameras will make people think twice before attacking hospital staff who are trying to ensure the good health and well-being of patients.

Progress still needs to be made however, on protecting those working in primary and community care – especially the lone workers who are particularly vulnerable. I blogged earlier in the year on what BMA Cymru believe would be the most effective mechanisms to eradicate the problem.

I hope that this pilot will prove successful and demonstrate that violence against healthcare workers will not be tolerated.

Have you been subjected to violence and aggression in the workplace? Tell us about your experiences.

Room for improvement

Auditor General Jeremy Colman, has today published a report entitled "Unscheduled care: developing a whole systems approach", which concludes that despite the strengths of the current system, there is work needed to improve the way which services work together.

The BMA has been calling for better service integration within the Welsh NHS for a long time - unscheduled care plays a key part in that agenda.

The report says that too many people who have urgent reasons to access the NHS or social services are encountering inefficiency, uncertainty and delays. Jeremy Colman says that a solution to this would be to show people how their needs can be met more effectively elsewhere.

It may sound obvious, but ensuring that patients are seen or treated in the right place at the right time will make a big difference to the efficiency of NHS services and so it is essential that we get that right.

The report recommends that the new LHB’s should take the lead in redesigning the structure of unscheduled care. I hope the Minister considers this and will take the appropriate action to address the issue. Of course, any changes must be backed by an effective channel of communication and better working practices.

In addition, universal targets for seeing patients in A & E Departments are skewing priorities – patients in more need should be prioritized and treated accordingly. That is just not happening at the moment. The use of smarter targets is a real solution to that and something we have been encouraging the Assembly Government to look into.

We must be careful not to undermine what we already have in Wales both in general practice and in secondary care. We need services that support and compliment each other – the danger which has become apparent is that unscheduled care has become a separate and isolated part of an already disjointed service.

At a time where NHS reorganisation is taking shape, it is crucial that the Minister acts now, so that the future benefits of the NHS in Wales can be fully realised. We would very much welcome the opportunity to work with the Assembly Government and the new LHBs on improving the service.

If you have any thoughts on the report, let me know.

Chief Medical Officer for Wales publishes Annual Report

Wales’ Chief Medical Officer Dr Tony Jewell, has today published his annual report which looks at different methods of prevention to ensure the long-term health of the nation, including immunisation, screening and education.

He warns that preventing disease and illness is the key to a healthy future generation. I welcome this report and agree with the recommendations Dr Jewell sets out for improving the health of the nation. It is vital to focus on health promotion and illness prevention as well as illness itself.

Dr Jewell says that overall health in Wales is continuing to improve, but continued action is still needed to address issues like obesity, binge-drinking and smoking. These three issues are important for BMA Cymru members, and for years we have been trying to improve the health of the nation by campaigning for smoking bans, minimum pricing for alcohol and preventing childhood obesity.

The effect of the smoking ban is noted by Dr Jewell in the report. Findings from research commissioned by the Welsh Assembly Government show clear evidence of reduced exposure to environmental tobacco smoke, particularly in pubs, clubs, bars and at work. This means that the legislation has achieved its main objective to reduce environmental tobacco smoke. It is encouraging that the studies found no evidence of any shift of smoking to the home, or of increased exposure to children.

BMA Cymru would like to see further action taken by the Government in the long run, including banning advertising and displaying cigarettes at point of sale; as well as banning cigarette vending machines and scrapping the sale of ten packs.

Childhood obesity is a growing epidemic, and the soaring rates have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers. Teaching children at an early age about the advantages of a healthy lifestyle and introducing exercise into a daily routine may prevent them from chronic health conditions later on in life.

A sensible approach to alcohol is always important, but it is particularly pertinent at this time of the year. We want the public to be aware of the risks associated with drinking, and would like to see advertising for alcohol banned as well as minimum price levels for the sale of alcohol.

Health Minister Edwina Hart has welcomed the report and the recommendation that more focus should be placed on preventative measures. I look forward to seeing what action the Welsh Assembly Government takes. Let me know what you make of the report.

You say goodbye and I say hello…..

Rhodri Morgan will formally step down as First Minister of Wales today, and I would like to wish him well for the future.

After 10 years as the Leader of Wales, Rhodri leaves a great legacy behind him. Under his leadership we have seen devolution take shape and flourish, and his commitment to Wales is admirable. Over the last 10 years Wales has remained loyal to the true values at the heart of the NHS. We have gained free prescriptions and free hospital parking, and maintained a clear rejection to the introduction of competition, choice and greater use of the private sector.

The approach to healthcare in Wales has been compared to England by Morgan, as “clear red water”. This rejection of the internal market has become part of Welsh identity. Instead of targets and choice, we invest in community and preventative measures, and in promoting public health.

During the rest of this Assembly I look forward to BMA Cymru working with Wales’ new leader Carwyn Jones, to ensure that Wales is the premier place for doctors to come and train and work.

The recruitment and retention of junior doctors must be high on the Government agenda moving forward. If we don’t have the quality and quantity of doctors, the health service will fail to function. This is a great concern to us and our members.

I hope that he and the Health Minister will work with us to build a health system that delivers better health for the people of Wales. We realise that we are in the middle of a recession, and difficult decisions will have to be made, but it is vital that health is properly funded.

So fare-well Rhodri, and welcome Carwyn, we look forward to working with you.

Less talk, more action!

First Minister Rhodri Morgan, has voiced his fears for a “toxic generation” of children who play computer games and eat junk food.

I share his concerns, and fear that we are in danger of raising a generation of children burdened with long term chronic health conditions. Soaring rates in obesity have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers.

Small changes to a daily routine can make a real difference. Just getting children into the habit of walking to school has environmental benefits, and helps with the fight against childhood obesity. Teaching children at an early age about the advantages of a healthy lifestyle often means that they will continue this into adulthood. I’m not saying it’s easy, but it is vital that we act without further delay.

In order to achieve a real improvement for the future health of our children; parents, schools, health professionals, the media, food manufacturers, and the government all have an important role to play.

We need real action from the Welsh Assembly Government on what is going to be done to reverse this growing epidemic. What do you think?

Option 7 campaign extended

BMA Cymru Wales has decided to extend the Option 7 campaign which is aimed at improving the lives of junior doctors in Wales.

We have taken this decision due to the increasingly alarming picture which has emerged since we launched the campaign in July this year.

Junior doctors have been afraid to voice concerns for fear of repercussions. I want to re-iterate the message that the option 7 phone line is completely confidential. If you are experiencing a problem with insufficient locum cover, intimidation, lack of training opportunities or anything else, please do contact us.

Together with BMA Welsh council chairman Dr Andrew Dearden, I have been meeting with the chairs and chief executives of the new NHS health boards in Wales where we have been offering support to employers to resolve the problems highlighted, and have been drawing up an action plans to resolve these problems. We have also met with many junior doctors to really get to grips with the issues that we are faced with.

The types of problems that have been reported to us will not be tolerated. It is vital that you come forward so we can put an end to what could be affecting careers and patient safety.

If you are a junior doctor and wish to raise a concern with a BMA adviser the hotline number is 0300 123 123 3, then select option 7.

You can also fill out a form on the BMA website.

To get involved and show you support for our campaign, join our facebook group.

And follow the campaign updates on Twitter.

The postcode lottery strikes again

The Healthcare Inspectorate Wales, the Wales Audit Office, Estyn, and the Care and Social Services Inspectorate Wales have today published a worrying report on the state of Mental Health services for children and young people in Wales. This is the first time that all four bodies have come together for a service review, which highlights the seriousness of the failings in the service provision.

Although acknowledging recent improvements including the introduction of primary mental health workers who support professionals, such as GPs and school nurses working with children and young people, the report also brings to light those areas in dire need of improvement - especially stressing the variation across Wales in the availability and quality of services. Unfortunately we know all too well that a postcode lottery is a common problem across the board of service provision.

The report also found that Wales is the only place in the UK with no specialist mental health services for children under age five. Why is Wales lagging behind the rest of the UK again?

The Health Minister responded that the findings are "out of date" and "do not reflect wider improvements". However, despite the improvements already made, it is clear that there is a long way to go in improving services for children and young people suffering with mental health conditions. It is time that we stop failing and start helping the young vulnerable children whose lives could be dramatically improved by an early intervention. Let me know your thoughts on the findings.

Minimum price demand on alcohol –in the news again

I'm pleased to hear that Social Justice and Local Government Minister Dr Brian Gibbons is in discussions with the Scottish Government regarding their plans to introduce legislation on the minimum pricing of alcohol, and has called for action in Wales saying we should follow Scotland’s example.

Although we do not have the powers in Wales to formulate similar legislation yet, I hope this is something that we will see progressing soon. The BMA in Wales has campaigned on alcohol issues for years, and we remain committed to finding practical solutions to the problems we are facing relating to alcohol.

We are not out to ban alcohol – we just want to ensure that the public are aware of the risks associated with drinking, and to promote a sensible approach to it’s intake.

Dr Gibbons has expressed his concern that a person can consume more than their desired daily intake of alcohol for less than £1. Cheap alcohol and marketing has led to a society in which the entire population is drinking more than ever, posing serious risks to health of the nation.

It is time that the Government in Wales took control of this situation. The population is drinking in increasingly harmful ways and the result is a mixture of avoidable medical, psychological and social harm, damaged lives and early deaths.

Earlier in the year we published a report examining the damaging effect of alcohol marketing on young people. To read the report in full click here: "Under the influence - the damaging effect of alcohol marketing on young people" and tell me what you think.

A clearing in the fog?

The devolution settlement in Wales has often been referred to as a ”fog” , but today, the All Wales Convention has reported that the Assembly in Wales should be given full law making powers through a referendum, so there could be a clearing ahead.

The Convention, established by the Welsh Assembly Government, also said that a yes vote for further powers is attainable, that public support is out there, although it is not guaranteed.

For us, the transfer of full-law making power for Wales would be a welcome development on the current system.

BMA Wales gave evidence to the All Wales Convention earlier in the year, and I am pleased to see in the report that the evidence we submitted has been taken on board and cited on numerous pages.

We noted in our evidence that the current system by which the National Assembly can acquire legislative powers is cumbersome and thus not widely understood by the public in general - including BMA members.

In the context of a UK membership organisation, professional association and trade union that the BMA is, there is often central confusion about the extent to which the National Assembly for Wales can legislate in health matters. This can lead to Wales being left behind as it does not have the same tools available to implement BMA policy as is available to our counterparts in other nations. In contributing to debates on policy, in particular on a UK basis, it would be far more straightforward for members in Wales to be reassured that similar legislative change as is often proposed for Scotland and Northern Ireland could also be implemented in Wales by Welsh Ministers.

At the moment, the ability to develop and implement new policy via the legislation route is let down by the need to obtain ‘permission’ from Westminster, and the subsequent delay in that process. Using BMA Wales’ experience with the introduction of a ban on smoking in public places, we highlighted problems inherent within the present system. Although Wales were at the forefront in calling for a ban, ultimately the ban was only implemented marginally ahead of that in England, even though Wales had started the process much earlier. The delay in legislating in Wales caused by the lack of primary legislative powers can be argued to have led to many individuals health being damaged by exposure to environmental tobacco smoke in the interim period.

The report suggests that the Assembly should decide on whether to hold a referendum by June 2010, well in advance of the next Assembly elections. The timing of a referendum is clearly one for the politicians but the view of BMA Wales is that we support primary powers simply to allow effective, timely and consistent policy change in health (and the related portfolios) and to enable the Association work effectively with our members – on an equal footing as our colleagues across the UK.

I look forward to further developments – and to the statement by the First Minister next week.

WELCOMED: Proposals to Close Sunbed Regulation Loop-hole

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

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

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

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

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

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

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

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

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

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

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

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

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

HIV Related Discrimination by Healthcare Professionals

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

This by its very nature is a difficult issue.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some Good News on World Stroke Day

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

A very welcome development.

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

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

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

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

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

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

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

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

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

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

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

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

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

What Wales needs is a comprehensive action plan on stroke.

Out of Sight: Out of Mind

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

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

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

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

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

Reporting patient safety concerns will lead to better patient care

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

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

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

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

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

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

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

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

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

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

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

Campaign Success – Every Welsh Council Leisure Centre soon to be Sunbed Free

We are absolutely delighted that after our recent sunbeds campaign, the three remaining local authorities in Wales (Vale of Glamorgan, Flintshire and Wrexham) who continued to operate and profit from sunbeds are on the road to removing them.

That means by April next year, no local authority owned leisure centre will operate sunbeds.

Our campaign exposed the shocking profits the three Councils were making from sunbeds – a combined profit of around £46,000 annually.

After our success in securing a commitment from the Vale of Glamorgan to remove the five sunbeds it operated across the county we pledged to take the campaign to North Wales – to Wrexham and Flintshire – who were the only ones left operating sunbeds.

The fact that the Vale has already bowed to pressure and removed its sunbeds and Wrexham Council have agreed to remove the ones it operates by April next year, is a great result for local public health. Next week, Flintshire Council’s Executive is to consider the issue and is expected to announce the removal of all sunbeds before the end of the year – determined not to be the last authority in Wales to do so.

The link between exposure to UV radiation and skin cancer is now indisputable – shown by the recent decision by the International Agency for Research on Cancer to raise the sunbed classification to “carcinogenic to humans” and the fact that the sunbed industry is largely unregulated in the UK.

The removal of all sunbeds operated by local authorities sends a clear message to the public on the dangers of sunbed use.

We’ll continue fighting for tighter regulation of the Commercial sunbed industry – especially for a ban on coin-operated / unsupervised salons and use by under 18s, a move we understand the Assembly's Health Minister has asked her officials to look into.

Exposing Wrexham Council’s sunbed profits

Our continuing campaign to highlight the dangers of sunbeds has revealed figures showing that over the last five years Wrexham Council has generated in excess of £83,000, by operating ten sunbeds in three of its leisure centres.

We were able to obtain the figures under a Freedom of Information request. And we are now calling for the immediate removal of all sunbeds from local authority-owned premises and for tighter regulation of the sunbed industry.

The figures are all the more shocking when you delve a bit deeper and see that the Council only began operating two of the sunbeds, at its Plas Madoc leisure and activity centre just last month.

Leaders on Wrexham Council have shown a blatant and reckless disregard for the health and well-being of the people they represent. They may well be making a lucrative profit from sunbeds, but you cannot put a price on good health. I’d go so far as to say that the Council’s conduct is unforgivably irresponsible.

The Council has told us that it is planning to remove all sunbeds by April next year, so why then have two more installed in the last few weeks? Such a move can only be put down to a last ditch attempt to make more money, putting profit before health.

The BMA’s recent criticism of the Vale of Glamorgan Council, who made an £15,000 annual profit from the five sunbeds it operated, led to that authority removing sunbeds from its leisure centres across the county. Since then we’ve pledged to continue in our fight to get Wrexham and Flintshire Councils, the last two in Wales to operate sunbeds, to remove them.

I don’t think the BMA is alone in believing that as a locally elected government Wrexham Council has an obligation to protect the health and welfare of local people. By ignoring the well-known and accepted scientific and medical evidence on the dangers of sunbed use, Wrexham Council has wilfully reneged on this duty of care.

Just one session a month on a sunbed doubles the average individual's annual dose of UV radiation and this is proven to greatly increase the risk of cancer, skin and eye problems in later life.

In 2009, there is no excuse for sunbeds to be operated by Local Authorities, especially in leisure centres which should be places of recreation, exercise and well-being. There is also no excuse for the current lax regulation of the commercial sunbed industry across the UK generally. When the BMA gives evidence to the National Assembly’s Health Committee inquiry in two day time, we’ll be highlighting all these issues.

NOTES –

WREXHAM COUNTY BOROUGH COUNCIL SUNBED ANALYSIS

FACILITY/LOCATION
Wrexham Waterworld
NUMBER OF BEDS SINCE 2002 - 2
NUMBER OF BEDS SINCE 2008 - 1
CHARGES - £3.20
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
04/05 - £7,765
05/06 - £5,909
06/07 - £4,772
07/08 - £5,168
08/09 - £3,590

FACILITY/LOCATION
Queensway Stadium
NUMBER OF BEDS SINCE 1996 - 2
CHARGES - £3.20
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
04/05 - £9,205
05/06 - £6,311
06/07 - £3,530
07/08 - £2,987
08/09 - £2,648

FACILITY/LOCATION
Plas Madoc
NUMBER OF BEDS SINCE 1990 - 3
NUMBER OF BEDS SINCE - August 2009
CHARGES - £2.50
MONITORING/BOOKING INCOME £
Maximum 20 sessions per year
05/06 - £6,702
06/07 - £11,091
07/08 - £8,764
08/09 - £5,190

ALL sunbeds will be removed by 1st April 2010.

ALL income generated would be offset against the departments deficit incurred in operating the Sports and Physical Activity service.

Action after inquiry needed on stroke services in Wales

BMA representatives have given evidence this morning to the Assembly’s Health, Wellbeing and Local Government Committee inquiry into Stroke Services in Wales. Several other groups with an interest in this area have also given evidence, along similar lines to ours, so here’s hoping the committee listens and acts on the recommendations of the majority.

A stroke can be devastating condition and is the third most common cause of death in the UK; 11,000 people have a stroke in Wales each year.

Strokes leave one third of patients permanently dependent on the help of others and is the biggest cause of severe acquired disability in the UK.

The treatment and management of stroke is now supported by a good body of quality evidence and we have witnessed a number of medical advances in recent years. As a result acute stroke is increasingly becoming a treatable condition.

That’s one of the reasons why BMA Cymru Wales welcomes the Welsh Assembly Government’s decision to make improving stroke services a priority - as a result the last few years have seen improvement in stroke care across Wales. However so far, this has not gone far enough. In almost every area of stroke care Wales lags behind that of England and Northern Ireland. There are pockets of good practice but the patchy provision of services across the country indicates that much more needs to be done.

If we are to see real improvement in the treatment and services available to stroke patients across Wales, the WAG needs to take act on the points listed below;

• A Wales-wide doctor recruitment and retention strategy, with an emphasis on specialist stroke physicians and neurologists.

• Everyone in Wales should have access to a stroke unit within 30 minutes travelling time of their home and the units should;
* Offer round-the-clock care with access to thrombolysis and scanning equipment
* Be adequately staffed (doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians, psychologists, social workers)
* Have adequate bed capacity
* Have strong links with rehabilitation and support services

• The new LHBs should:
* Make it someone’s responsibility to lead the team and champion the improvements within their areas and offer local solutions;
* Greatly increase the number of whole time equivalent medical hours allocated to stroke treatment and management;
* Work closely with local authorities and others to create multi-disciplinary care partnerships ensuring joined up working and continuous care provision;
* Interpret national guidance into effective local delivery by considering what is best to meet the challenges of that particular area. In this way national guidance should be broad and flexible;
* Facilitate research and data gathering through, for example, local clinical research networks - working with other LHBs to take a Wales-wide view of stroke services;
* Utilise the new Professional Forums and Stakeholder Reference Group as a mechanism to highlight stroke issues.
* Facilitate public awareness and education campaigns.

• Given the importance in receiving treatment immediately after a stroke, people should be directed straight to hospital, ambulance staff should be specially trained in the early treatment of stroke victims, and information should be sent to GPs to support direct referral.

• A national public awareness campaign is needed to highlight the prevalence and severity of stroke, how to recognise the symptoms, and that it requires a 999 response. The FAST (Face, Arms, Speech, Time) campaign did some good work in relation to this but needs to be built on – for example, the ways to recognise transient ischaemic attacks (TIA), the risk factors such as high blood pressure and diabetes, high cholesterol, smoking, excess alcohol intake and recreational drug use should also be highlighted. Many people still do not realise that strokes are preventable, do not know the symptoms or risk factors, or how to manage them.

• A training programme should be developed for stroke treatment across the multi- disciplinary teams working within the primary and secondary care sector to ensure efficiency and confidence when treating or managing stroke. Training should also be extended to carers.

• The long-term impact of stroke on families and carers needs to be looked at and their views sought.

• Current policy on Stroke - the National Service Framework for Older People, the Stroke Improvement Programme and the Stroke Pathway – are useful but we also support the development of a Stroke Strategy for Wales accompanied by a solid and achievable Action Plan.

New fee scale for dispensing doctors

The BMA’s General Practitioners Committee (GPC) and NHS Employers have agreed a new fee scale for dispensing doctors, which will come into effect next week, 1st October 2009.

The fee scale for dispensing doctors will be lowered by 8.7 per cent for the remaining six months of the financial year, representing a 4.9 per cent decrease across the whole year.

And, as of 1st April 2010, there will be an increase to produce a figure that is appropriate for the full new financial year.

Understandably this has left GPC disappointed. Many patients in rural areas rely on dispensing practices to obtain their medicine and the BMA’s very concerned that NHS Employers have underestimated the costs of providing dispensing services, which inevitably rise with increasing volume.

The ‘cost of service inquiry’ should help develop a fairer cost analysis and reimbursement structure in future, but the government needs to act urgently to deal with the unilateral withdrawal of discounts by many of the drug wholesalers, which could threaten the viability of some dispensing practices.

Surgeons’ overtime bill highlights more deep-rooted problems within the Welsh NHS

The front page of the Western Mail today highlights an issue that has been of concern to BMA Cymru Wales for some time - the need to adequately staff the Welsh NHS.

The over-reliance on overtime and private hospitals to try and ensure waiting time targets are met, is merely using a sticking plaster to patch up what is a much more serious problem. There has been insufficient investment in the NHS in Wales over the last few years, with the default position becoming one of buying additional capacity through short-term schemes. Surgeons do not work on their own, they’re part of a team, including anaesthetists, nursing and other clinical staff. Extra resources are therefore needed to manage these issues long-term, with the employment of more surgeons, anaesthetists and nurses.

NHS staff are being pushed to the limit to deliver the 26-week access targets by December, set by the Welsh Assembly Government. Added to this is the impact of the European Working Time Directive, introduced in August, with many doctors being encouraged to work above the 48-hour limit set by this legislation.

It may not be what either politicians or patients want to hear, but if the current financial pressures do not allow for the NHS in Wales to be better resourced, then maybe it’s time for the WAG to scrap targets, as without extra resources, quality of care will undoubtedly suffer, which certainly isn’t in the best interests of patients or doctors.

Scrapping GP catchment areas – superficially attractive but not essentially practical

Good to hear that this isn’t a priority for the Welsh Assembly Government as the BMA can see many drawbacks to the idea of scrapping GP catchment areas.

For a start, the rest of the health service and social services and county councils all work by boundary areas, and so to just suddenly take general practice out of that system, would be terribly complicated and actually very difficult to make work.

It would be hard for patients to access a doctor in more rural areas - how would they get home visits when they are ill, if they are registered miles away, near their place of employment?

Also what would happen to practices that are destabilised because some of the younger, healthier patients have gone elsewhere? Surgeries with a mix of patients, where some don’t visit their doctor that often, help general practice to be cost-effective. If younger people register near their workplaces, some practices could be left with patient lists mainly composed of those with long-term conditions and complex illnesses, severely disadvantaging some practices.

We do support boundaries being a little more flexible, so long as practice organisation isn't interfered with. We also support practices trying to make it as easy as they can for patients to see their regular doctor whenever possible. Our main concern though is not to disadvantage the most vulnerable, which these changes could possibly lead to.

So for the Department of Health to argue that the main reason for scrapping GP surgery boundaries is to increase patient choice, is in essence a false one, with many surgeries perhaps having to close as a result of these changes. This seems to be change for the sake of it.

Posted on behalf of Dr David Bailey, Chair of GPC Wales.

Swine flu vaccine agreement reached for Wales

Agreement for a swine flu vaccination programme to be rolled out by GPs across Wales, I am pleased to say, has been reached.

General practice is an efficient and adaptable model that reaches into every community in Wales and is best placed to deliver the vaccination. GPs are used to delivering large scale vaccination programmes that target patients at highest risk and this agreement means that GPs and their teams will have the resources they need to take on the additional workload and run the vaccination programme smoothly and efficiently.

This agreement is testament to the cooperative work we have produced with the Welsh Assembly Government and our GP members look forward to delivering the protection for vulnerable groups that the people of Wales deserve.

A ban on violent patients doesn’t seem so "understanding"

And just to add to my earlier blog post on violence and aggression, whilst we support the memorandum of understanding, we wouldn’t go as far as calling for people who are violent towards NHS workers to be banned from using frontline services, which is what Barbara Wilding, the Chief Constable of South Wales police seems to be advocating. A tougher approach is needed, we definitely agree with that, but to try and prevent people from accessing NHS services would be a potential violation of their human rights and goes against the very ethos of the NHS – health services accessible to all. Better surely that we focus on the points made in my earlier blog than to be so draconian?

More than just understanding is needed to tackle violence and aggression in the Welsh NHS

This development is a step in the right direction and should help with the investigation and prosecution of alleged attacks against doctors and the wider medical profession.

Action to show people that violent behaviour will not be tolerated is long overdue with the problem becoming more widespread. More than 7,000 incidents were reported in the NHS in 2007-08. It is also an area that we have been calling for action for several years now, having been made aware of many incidents where our members have been victims of violence and aggression. As far as BMA Cymru Wales is concerned, it is totally unacceptable and inexcusable to attack a doctor, or any healthcare professional in the line of duty, when they are trying to ensure the good health and well being of patients.

There is still much to be done in completely stamping out this problem, which, to many of our members is sadly becoming part of the norm of their daily working lives.

To stand alongside this memorandum of understanding, BMA Cymru Wales is calling for the following;

• A register of violent patients - If a doctor, nurse or other healthcare personnel can be alerted in advance to the possibility of a patient becoming violent, s/he will be forewarned and no longer placed in a position of vulnerability, through a lack of relevant information.

• Training and Communication - Ensure that all staff are fully trained and are aware of the mechanisms to report physical or verbal abuse and that they are encouraged to report incidents.

• Staff Support - Ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident.

• Public Awareness - Patients and healthcare users need to know that they are not outside of the law while in contact with healthcare professionals and that those offenders will be brought to justice.

If these measures are brought in to force as well, then we really could be well on the way to eradicating this, unfortunately, growing issue.

The WAG could be storing up a whole heap of problems over a lack of GPs

It seems as if nothing has changed yet then in terms of the future of the GP workforce in Wales, or if it has, it’s only a change for the worse. The latest round of “Workforce Statistics for General Practitioners in Wales, 1998 – 2008” just serve to highlight how much of a ticking time bomb Wales is sitting on when it comes to having enough GPs to serve the population. Put simply, the figures show how those GPs coming up to retirement age aren’t being replaced by younger doctors. I blogged on this particular issue earlier this year and so these stats just back up everything I said then.

There are several reasons as to why Wales may soon be facing a GP shortage, a key one being demographics, with lots of older, single-handed GPs coming up to retirement age in the valleys. Also in Wales, GP incomes are lower than their counterparts in England, but with a higher workload than England. There may also be less opportunity for surgery partnerships in Wales. Then of course, there has been the trend over recent years (and rightly so) for an increased emphasis on work/life balance, making it easier for more GPs to work part-time.

And just as there is no one reason, there probably isn’t one easy solution to what could be a very serious issue in the coming years. The reorganisation of the Welsh NHS is due to really come into effect over the next few weeks, which sees a greater emphasis on the role of GPs and primary care, so it really is about time that the Government here starts taking the recruitment and planning of the Welsh GP workforce seriously. Otherwise, as the old classic song goes "There may be trouble ahead..."

Life as a junior doctor isn’t car "crash" TV

I was intrigued to hear about a new TV series, “Crash” which started on BBC1 last night, focussing on the lives of junior doctors, who’re just embarking on their medical careers and it is good to see this area of the medical profession being given such a prominent platform. I was curious though to find out how true to life it might actually try to be. However, as it’s been a while since I was a junior myself, this might be better coming from Dr David Samuel, chairman of the BMA’s Welsh Junior Doctors committee. So here’s his take on the show...

A hard-hitting, fast paced drama, which portrays the challenges and sometimes adverse conditions facing a junior doctor. The actors created a realistic portrayal of the nervous tension that flow through the veins of every new doctor, as well as giving some insight into some of the non-clinical issues facing hospitals across the country. Although some of the behaviours were not in keeping with good practice, the interactions between staff and patients were realistic - the use of dialect to communicate appropriately puts the more realistic dramas to shame where clinical jargon fills the ears of confused patients.

The only shame was that one of the show's stars was lost so early on but even this scene was skilfully executed.

I look forward to the next episode to see more flashbacks of my own year as an F1!

Calling time on alcohol promotion

The BMA has launched a new report today looking at the effects of drinks promotions, particularly amongst young people.

We’re calling for a total ban on alcohol advertising, including sports events and music festival sponsorship as well as promotional deals like happy hours, two-for-one purchases and ladies’ free entry nights.

“Under the Influence”, also renews the call for other tough measures such as a minimum price on alcoholic drinks and for them to be taxed higher than the rate of inflation.

Over the centuries, alcohol has become established as the country’s favourite drug. But the reality is that young people are drinking more because the whole population is drinking more and we now see pro-alcohol messaging, marketing and behaviour everywhere. In treating the issues around drink, we need to look beyond just young people and at society as a whole.

According to the World Health Organisation, alcohol is the leading risk factor for premature death and disability in developed countries, after tobacco and blood pressure. It’s related to over 60 medical conditions, costs the NHS millions of pounds every year and is also linked to crime and domestic abuse.

Alcohol consumption in the UK has increased rapidly in recent years. Household expenditure on all alcoholic drinks increased by 81 per cent between 1992 and 2006. At the same, never before has it been so heavily promoted.

The drinks industry spends £800 million a year in promoting alcohol in the UK. So it’s little wonder that we see it everywhere – on TV, in magazines, on billboards, as part of music festival or football sponsorship deals, on internet pop-ups and social networking sites. Given that teens often don’t like the taste of alcohol, new products like alcopops and toffee vodka are developed and promoted because they have greater appeal to young people.

The BMA is not calling for a ban on alcohol. As doctors, our focus is to ensure that individuals drink sensibly, so they don’t put their health and lives in danger.

There was a time when it was regarded the norm to see cigarette adverts and people smoking on buses, trains, airplanes and in restaurants. When the BMA initially called for a ban on smoking in all enclosed public places, there was a general outcry about it. But I doubt most people would want to return to the days of smoky pubs now. There has been a cultural change for the better and this now needs to happen with alcohol.

As this report points out, it would seem that brand development and stakeholder marketing by the alcohol industry, including partnership working and industry funded health education, have served the needs of the alcohol industry, not public health.

We have a perverse situation where the alcohol industry is advising our governments about alcohol reduction policies. As with tobacco, putting the fox in charge of the chicken coop – or at least putting him on a par with the farmer – is a dangerous idea. Politicians showed courage before by not bowing to the tobacco industry, they need to do the same now and make tough decisions that will not please alcohol companies.

Key recommendations from the report include:

• There should be a ban on all alcohol marketing and promotion
• UK governments should establish minimum price levels for the sale of alcoholic products
• Tax increases on alcohol should be set above the rate of inflation and be linked to the alcoholic strength of products
• A reduction in licensing hours for on- and off-licensed premises should be introduced

Read the report in full - “Under the Influence – the damaging effect of alcohol marketing on young people”

New award to honour GPs and Consultants in Wales

Just to highlight to our members - a new initiative by Cardiff University - to honour Wales’ best medical supervisor or trainer.

The Wales Deanery Best Educational Supervisor and Trainer (BEST) Awards 2009 have been launched by the University’s School of Postgraduate Medical and Dental Education. They have been set up to honour GPs and Consultants who have shown excellence in the role of Educational Supervisor of Postgraduate Medicine in Wales.

Any Welsh doctor in training has until mid September to nominate who they think are some of the best medical educational supervisors in Wales. They can nominate Welsh GPs or Consultants, who they believe have performed outstandingly either primary care or secondary care.

Such awards are a great idea, illustrating how medical educational supervisors and trainers play a vital role in delivering high quality training programmes for doctors entering the profession and encouraging more trainees to look to Wales to work and live.

More information about the awards is available from Cardiff University.

Schools in Wales have a key part to play in our obesity battle

This campaign to get schools more involved in improving our health and fitness and in turn, hopefully helping to tackle obesity, really is a great idea.

Currently schools in Wales are perhaps something of an on under-used resource, with many closing their doors after 4pm on school days, not to mention being out of bounds on weekends and during school holidays.

One of the key factors stopping people from using leisure centres, particularly in more rural areas, is the cost and being able to access them. So it makes sense to utilise schools which are on the doorstep for most families. And with funding from the Welsh Assembly Government and the Sports Council for Wales, costs to the public are substantially reduced, or entry fees wavered completely.

This seems like a win-win situation to me. You have schools becoming the focal point of community activity, at the heart of where people live, being used in the evening and at weekends, meaning they’re less likely to be the targets of vandals and break-ins. As the same time they are providing a place for young people to go, occupying their time, so they don’t have to hang around on street corners. Plus, there is the added benefit that it encourages us all to get out of the house and get active. And this has never been more necessary, with more and more statistics these days to remind us how we’re piling on the pounds.

I really hope more schools in Wales now take the opportunity to open for longer and help to play a part in stemming what is fast becoming an obesity epidemic in the UK.

Vale of Glamorgan Council sees sunbeds sense

Congratulations to the Vale of Glamorgan Council on making the right decision and removing the five sunbeds it operates in leisure centres across the county.

We have recently criticised the council for dragging its feet over the enforcement of a recommendation to remove the sunbeds, so it’s great that the Council Executive has finally seen sense and resolved to get rid of them.

The Vale Council was the last Local Authority in South Wales to operate sunbeds.

It should never have had sunbeds on its premises. The fact that an attractive £15,000 profit was made annually for the council might go some way to explain the delay in removing them.

This decision is an extremely important one in terms of promoting local public health and wellbeing and it also helps to spread the message about the dangers of sunbeds and UV exposure. A message which both Flintshire and Wrexham – who are the only local authorities left in Wales still to operate sunbeds in their leisure centres – would do well to listen to.

The BMA will continue to call for these two remaining Local Authorities in North Wales to remove the sunbeds they run. They should be leading on health protection; operating sunbeds is simply reckless and irresponsible.

Leisure centres should be places of health, recreation and well-being, not places which provide facilities that are so damaging to a person’s health. Just one session a month will double the average individual's annual dose of UV radiation and this has been proven to greatly increase the risk of cancer, skin and eye problems in later life.

The view of the BMA has always been that there is no such thing as a safe tan (unless it comes out of a bottle). When a tan fades the damage to your skin remains. We want to see tighter regulation of the sunbed industry and a ban on coin-operated, unmanned salons. When we give evidence to the National Assembly’s Health Committee later this month that’s exactly what we’ll be calling for.

Childhood obesity – prevention is better than cure

I fully support this article by Sustrans Cymru.

To maintain good health and keep obesity at bay and other serious illnesses in later life, it is recommended that children have at least 60 minutes of moderate exercise every day, such as brisk walking, running, or cycling. But, research suggests that currently only around half of seven to 11 year olds manage to do this. So it's essential to get kids moving. And the journey to and from school is the perfect place to start. We know that, particularly in deprived areas, many parents are scared to let their children go outside because the roads are so busy. That is why we are in favour of 20mph zones in urban areas, and specifically around schools in Wales.

The number of children travelling to school by car has doubled over the last 20 years. Getting youngsters into the habit of cycling to school has obvious environmental benefits, and of course, helps with the fight against childhood obesity too. That’s why the Bike It project being trialled in three areas in Wales is such a good idea. It helps to establish cycling to school as part of a routine, not a one-off occurrence.

There is no precise figure of how much obesity costs the NHS, but every year the health service spends at least £2 billion on treating ill health caused by poor diet. Estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020. Therefore the cost to the health service is likely to increase unless measures are put in place to halt this growing problem.

We need now, more than ever, to be focussing on preventing childhood obesity. We know that parents want to do the best for their children and getting them out of the car more is certainly one way of doing so.

Revalidation in Wales

Just to make you aware of a revalidation event which BMA Cymru Wales is organising, to be held in Cardiff on October 21st 2009.

Chairman of the General Medical Council, Professor Peter Rubin will be speaking at the event and wants to hear doctors' views about how revalidation should be implemented in Wales.

This event is open to ALL doctors (whether a BMA member or not)in Wales.

If you would like to attend please email BMA Cymru Wales CEO Sarah Miller - smiller@bma.org.uk

It would be good to get as many doctors there as possible, to get a wide range of views.

Chairman of Welsh Council Invites Questions

The Welsh Secretary’s blog is part of a wide range of social media initiatives to ensure communication with our members is as accessible and wide-ranging as possible.

While trying to keep our members and anyone else who reads this blog up to date with current activities, hot topics and general policy position of BMA Cymru Wales, it is also an opportunity for YOU to put questions to the BMA.

Our Chairman of Welsh Council, Andrew Dearden, is particularly keen to receive feedback or questions from our members, whether it concerns junior doctor issues, our Option 7 Campaign, EWTD, etc. So if you have any questions for Andrew please post them here. In fact, if you have questions for any of the Chairs of our committees (GPs, Consultants, Public Health, Medical Students etc) I know they would be delighted to hear form you.

Local authority continues to put profit before health

I have some serious concerns to share on here about the conduct of the Vale of Glamorgan Council, in particular, the way in which it appears to be dragging its feet over the removal of sunbeds in three of its leisure centres across the county.

Back in May, a Vale Scrutiny Committee recommended in a report to the Cabinet that the sunbeds should be removed. The Council have met three times since then and, in what can only be described as a “reckless failure to uphold their duty of care to the local population,” each time they have failed to consider the issue or take action.

The sunbeds are making a profit of around £15,000 a year for the Vale Council.

Now that the authority is in recess over the summer it will be September, at the earliest, that the recommendation to remove them can be put back on the agenda.

It is a step in the right direction that the dangers of using sunbeds have been recognised by the Scrutiny Committee, but it is difficult to see why the council have not yet taken action. I sincerely hope it simply isn't down to the finance the sunbeds generate. Surely local authorities have a duty of care to the people they represent and a duty to promote public health don’t they?

The Vale is not the only Council to have sunbeds in its leisure centres – Wrexham and Flintshire also do and we have called on them to take action too. Leisure centres, especially those owned by local authorities, should be places where people go for healthy exercise and recreation. Local Authorities should be leading on health protection. It’s absurd that sunbeds are even there. Just one session a month will double the average individual's annual dose of ultraviolet radiation and it’s well known that this increases the risk of cancer, skin and eye problems in later life.

The BMA has been a strong advocate for increasing community access to local leisure facilities and playing fields and has called for increased provision and investment to secure their future.

If leisure centres wish to diversify the facilities on offer, this should not be to the detriment of health and well-being. For instance, the beauty studio at Penarth Leisure Centre should offer fake tan sprays rather than the two sunbeds it currently hosts.

BMA Cymru Wales has campaigned for the tanning industry to be regulated for many years and when we give evidence to National Assembly’s Health Committee next month this is exactly what we’ll be calling for. Across the board we’ll be asking for tough action on sunbeds - including unmanned and coin-operated ones.

In the meantime we are calling on the Vale, and other Councils to act responsibly on behalf of the people they represent by removing the sunbeds at the earliest opportunity.

Juniors affected by exams mix up need our support

This really is an awful situation that these four young people are currently faced with and it’s very difficult to imagine how they must be feeling right now. That’s why BMA Cymru Wales will be doing everything possible to offer as much help and support as we can to get them through this.

Rest assured too, we will be seeking answers as to how such a fundamental error occurred and what changes will be made to make sure such serious mistakes are not repeated. However, at this moment in time, the key focus of our efforts is to ensure that those involved receive all the support we can provide.

Don’t delay in getting children protected against measles

I couldn’t agree more with this Western Mail article and the need to make sure children have been vaccinated against measles before the start of the new school year in Wales, in a few weeks time.

It’s only two counties in Wales which aren’t affected by measles, and with around 45,000 youngsters currently unprotected, this outbreak is only likely to get worse when schools go back after the summer holidays.

I have blogged on here before about the need for children to be vaccinated, particularly those who’re school-age and how damaging the unfounded allegations about the MMR jab from several years ago were, with the effects still it seems being felt today. So I think the need for a concerted drive to increase public awareness about the common misconceptions associated with the MMR jab has never been greater, as September approaches.

EWTD highlights the growing need for BMA Cymru Wales’ Option 7 Campaign

This Sunday Times article just goes to show how important and timely BMA Cymru Wales’ Option 7 Campaign is. Although this article refers to Scotland, the situation is more than likely being replicated in other parts of the UK. The Option 7 Campaign (named after the option on the BMA hotline) was originally set up because we were hearing of instances of intimidation/harassment/bullying of junior doctors before the introduction of the European Working Time Directive (EWTD) and chances are this has just exacerbated things. EWTD stipulates that juniors must not work more than 48 hours a week, but there are of course easy ways to get around this legislation, such as juniors being told to under report the amount of hours they are clocking up in any given week.

The European Commission must do more than “threaten” to investigate these allegations highlighted in The Sunday Times, it has a duty to do so, for the safety of both patients and NHS staff.

Junior doctors in Wales can also report their concerns to the BMA and they don’t need be a member to do so. Any information given will be kept completely confidential. Help us to help juniors by ringing the BMA on 0300 123 123 3 and select option seven.

Show your support for the Option 7 Campaign on facebook too, by joining one of our groups, follow the links below.

BMA Cymru Wales Option 7 Campaign facebook group

BMA Cymru Wales Option 7 Campaign Supporters of junior doctors facebook group

Peter Black AM: The English disease

Peter Black AM: The English disease

More warnings over health risks linked to alcohol

Health warnings in the news again concerning alcohol, but this is one that is perhaps not so well known. How many of us actually realised that drink could be linked to oral cancers? Cigarettes - definitely. But alcohol? It’s usually liver disease that is seen as being the number one health problem associated with alcohol, so could that soon be superceded?

It seems this is yet another reason for why drink should be consumed in moderation and to not accept the “binge drinking” culture that is so much the norm in the UK. This report from Cancer Research UK highlights that about three-quarters of oral cancers are thought to be caused by drinking alcohol and smoking.

The BMA has often outlined how doctors witness the devastation of alcohol on patients and the crippling effect it has on the NHS. So what price could we all soon be paying for the treatment of this huge increase in conditions like mouth cancer?

Just last month we repeated our calls at the BMA’s annual conference to have a minimum price for a unit of alcohol introduced by the UK government, partly because of the increased burden of alcohol-related diseases and complications on our nation’s health.

All the following points were agreed upon by members in July.

We…

ii) believe that a minimum pricing strategy would not unduly disadvantage responsible alcohol consumers;
iii) call for all alcoholic beverages to have clearer labelling indicating alcoholic content and unit value;
iv) call on the BMA to lobby government for a total ban on alcohol advertising in the media;
v) demand that revenue obtained from increased prices should be used for the prevention of alcohol misuse and the rehabilitation of alcohol abusers.

And reports like this one today just add more ammunition to our fight.

Tamiflu isn’t a wonder drug

This piece of BMJ research certainly grabbed the attention of the media yesterday. Though at the moment, anything to do with flu seems to get picked up on and linked to swine flu in some way.

As the research itself actually details “it is difficult to know the extent to which the findings can be generalised to children in the current swine flu pandemic but, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited.”

This is not to say that all children should not be given anitvirals like tamiflu. What perhaps we need to bear in mind is that we are learning more about antivirals, the more we use them. And while we know they are safe, we also know that vomiting and diarrhoea can occur in some children and adults who take them.

GPs have always said that doctors need to balance the risk of major complications from swine flu and the risks of side-effects from antivirals.

The more we learn about these drugs the more we will know how to treat patients with the most up-to-date clinical evidence. Tamiflu has a place in dealing with and containing the spread of swine flu, but it’s not a “cure all”.

Boxing bouts are not what youngsters need

This Daily Mail article made for uncomfortable weekend reading.

The BMA supports sports and hobbies aimed at improving children’s wellbeing and fitness, but not to the detriment of their long term health, which boxing can cause, such as potential brain damage.

It seems that it’s only schools in England who are looking at competing in these first inter-school boxing tournaments, which haven’t been around since the 1960s. Surely that’s where they should remain.

The BMA has campaigned for a ban on boxing since 1982 due to the physical dangers and harm it can cause. It can lead to brain damage, acute brain haemorrhage and eye, ear and nose damage. There is evidence that boxing not only causes acute brain injury but also chronic brain damage, which is sustained over a long period of time by those who survive a career in boxing. It may take many years before boxers and ex-boxers find out they are suffering from brain damage.

In 2005 the World Medical Association [WMA] stated that “Boxing is a dangerous sport. Unlike most other sports, its basic intent is to produce bodily harm in the opponent. Boxing can result in death and produce an alarming incidence of chronic brain injury. For this reason, the WMA recommends that boxing be banned.”

The re-introduction of boxing for youngsters leads to a bigger and more serious question for us as a society when, on the one hand, we’ve got repeated examples of young people attacking others on the streets and kicking them to death, which we seem to hear about far too often. It is then made difficult to explain to these youngsters who indulge in that kind of behaviour that they shouldn’t, when on the television they see adults punching each other, until one of them is knocked to the floor. It’s not really setting the best example now is it?

‘Boxing, an update from the Board of Science’ – the full report can be found on the BMA website at : http://www.bma.org.uk/ap.nsf/Content/boxing

Action not words now needed on organ donation

Around 30* people will have died in Wales in the last year, waiting for a transplant on the organ donor register.

That's why BMA Cmyru Wales is calling for action to be taken by the Welsh Assembly Government with regard to possible changes to the organ donation system.

It’s also a year since the Assembly’s Health Committee rejected any ideas to change the organ donation system in Wales.

This led to the Welsh Assembly Government’s wider consultation on the matter, which has just closed.

We submitted a response to this consultation, reiterating calls for a “soft” system of presumed consent to be introduced and to do so sooner rather than later, before more lives are lost.

There are several reasons why the BMA believes that such a system would produce a far higher potential donor rate than at present and in turn, save more lives.

The main difficulty with the current system is that where, as in the majority of cases, relatives do not know what their loved ones wishes are, they frequently, and understandably, opt for the default position, which is not to donate. This would be addressed by the introduction of an opt-out system where the default position would change in favour of donation. We recognise this is a subject many people hold strong views about and as such, those who do not want to donate their organs will sign up to opt out.

The number of people on the organ donor register has doubled since 2001, from 8 million to more than 16 million. But the gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

Presuming consent rather than presuming objection is also more likely to achieve the aim of respecting the wishes of the deceased person. Given the very high level of support for organ donation expressed in repeated surveys (up to 90%) it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not. With such a shift towards making donation the default position this reflects a positive view of donation, demonstrating the very strong support for it within society. Therefore, over time donation would come to be seen as the norm, rather than the exception.

Added to this is the fact that there is significant and growing public and professional support for such a shift. Recent public opinion polls show around 60-70% support for a shift to an opt-out system of consent for organ donation. This is consistent with the views found in the Assembly’s own public engagement exercise.

The time really has come, before more people die waiting in vain, the Welsh Assembly Government needs to stop procrastinating and seek an LCO (Legislative Competence Order) from Westminster to bring in a soft system of presumed consent.

*The figure of 30 people dying in the past year in Wales is based on 150 people dying in Wales waiting on the organ donor register in the last 5 years.

New Option 7 Campaign facebook group - for supporters of junior doctors

In addition to the last bog post, unveiling the launch of BMA Cymru Wales' Option 7 Campaign, we have now set up an additional facebook group, for friends/ colleagues/ family members of junior doctors in Wales to show their support for the cause.

Join the BMA Cymru Wales Option 7 Campaign - supporters of junior doctors facebook group and post your message of support too.

And thanks to everyone who has already joined the group(s) and are supporting our campaign!

The Option 7 campaign – to improve the lives of junior doctors in Wales

BMA Cymru Wales is today launching a campaign aimed at improving the working lives of junior doctors in Wales.

It’s previously been touched upon on this blog, but we have now become extremely concerned about the working conditions of junior doctors and the impact that this could have both on careers and on patient safety. This includes;

• Lack of training opportunities
• Unsafe staffing levels
• Bullying/ intimidation
• Non-compliant rota/ rota gaps
• Insufficient locum cover

Junior doctors are understandably afraid to voice any concerns themselves with senior management, for fear of repercussions.

So that’s why BMA Cymru Wales is launching the Option 7 campaign - named after the option on a BMA phone line that juniors can select, to discuss bullying and harassment in confidence.

The on-going campaign will involve myself and BMA Welsh council chairman Dr Andrew Dearden meeting with the chairs and chief executives of the new NHS health boards in Wales.

We are hearing of some worrying cases concerning junior doctors, which seem to be more widespread than just “one-off” incidents. I do think it has got to the point where it is starting to affect the reputation of training in Wales.

It is vitally important that we get the message out there that this type of behaviour cannot and will not be tolerated, no matter what the source, either from management or clinical staff.

In the meetings with NHS health board managers (chief executives and chairs), we will be offering support to employers to resolve the problems highlighted and drawing up an action plan of;

• What exactly will be done to address the issues
• Who will take responsibility for making sure action is taken
• Setting deadlines for action and resolving problems raised in these meetings

We will also be meeting as many junior doctors as possible during the campaign.

If you are a junior doctor and wish to raise a concern with a BMA adviser the hotline number is 0300 123 123 3, then select option 7.

You can also fill out a form on the BMA website.

To get involved and show you support for our campaign, join our facebook group.

View Dr Andrew Dearden and Dr David Samuel (chairman of the BMA's Welsh Junior Doctors Committee) talking about the campaign on BMA Cymru TV.

And follow the campaign updates on Twitter.