Update on BMA domestic abuse seminar

As promised, an update on Tuesday’s domestic abuse seminar, held by the BMA at the Norwegian Church in Cardiff Bay. First of all, I’d just like to thank everyone involved in making the event such a success, it was very well attended, perhaps in part due to the wide field of experts we had speaking there. And a special note of thanks to the speakers, Simon Jones – NSPCC, Professor Jonathan Shepherd – Director of Cardiff University’s Violence Research Group, Paula Hardy – Welsh Women’s Aid, DCI Martyn Dew – Gwent police and Dr Brian Gibbons – Social Justice Minister. It was really interesting to have such a broad cross-section of organisations, able to represent some of the different facets of domestic abuse.

There were quite a few statistics mentioned, too many perhaps to quote them all here. However, one that did stand out for me was the fact that a victim will be attacked at least 34 times, before first contacting police and seeking help.

Professor Jonathan Shepherd’s account of a patient he sees on a regular basis in his dental clinic, was also very powerful. The patient, who didn’t want to be identified, was stabbed repeatedly by her partner and continues to suffer post-traumatic stress and depression because of the abuse, re-living events constantly in her mind. A couple of things that have really helped her however was the response from ambulance staff and doctors who she said saved her life and also the continuity of care that she was given which meant she didn’t have to recount her distressing ordeal over and over again. The one drawback this particular victim found was a lack of any kind of support network and that despite the fact she wanted to talk to people about it, there wasn’t necessarily anyone there to listen.

I think there was general agreement that the Welsh Assembly Government has done a great a deal of policy work in the area of domestic abuse, perhaps more so than the Home Office when it was that Government department’s responsibility. There were several key recommendations made though as well, including the need to audit every A&E department in Wales over domestic abuse attendances, a better forensic medical service and to challenge the cultural acceptance by many that domestic abuse is the “norm” and “the way things are”.

Following on from this event, we’ll be putting together a report, which will detail all the findings and recommendations made on the night, which of course, I’ll post on here.

Despite the fact that invites were sent out well in advance to all 60 Assembly Members, only a handful turned up (including the Social Justice Minister who was speaking). I wonder what was more pressing than addressing this issue, which is undoubtedly a very real one for many of their constituents?

If you were unable to make the event, but would like to see more about what was discussed, here's the webcast of it.

Declaring war on the home front

We’re holding a seminar this evening to highlight what is still for many, very much a “hidden”, never-to-be-talked-about issue, at the same time as being a huge problem.

In Wales alone last year, an estimated 81,000 adults aged 16 to 59 were the victim of domestic abuse. This includes 46,000 women and 35,000 men. *

The fact that men and women live in fear day in day out, and are victims and prisoners in their own homes simply isn’t acceptable in Wales today.

In representing doctors across the country, I think that healthcare professionals have a key role to play, not just in providing medical attention or treatment, but in identifying and referring victims early on. I hope tonight’s event will focus on the multi-agency approach which is needed to move this issue forward.

It will be very interesting to hear what the likes of the Social Justice Minister, Dr Brian Gibbons has to say, along with representatives from Welsh Women’s Aid, Gwent Police and the NSPCC.

I’ll post an update on here about how it all goes!

*British Crime Survey Jan 2009.

Notifying members of the GMC’s new campaign “Licensing: It’s time to decide”

We want to make our members aware of the GMC’s new campaign “Licensing: It’s time to decide”. This is being introduced this autumn.

The GMC will be writing to all registered doctors over the course of the next few weeks, asking them to decide whether or not they want a licence to practise

After licensing is introduced, doctors wishing to undertake any form of medical practice for which the UK law currently requires GMC registration - such as writing prescriptions, and signing death and cremation certificates - will need to be both registered AND, hold a licence to practise.

More information about this is available on the GMC website - www.gmc-uk.org

Big Brother is watching – to help protect NHS staff

I know our members will welcome this announcement about a pilot CCTV scheme to deal with violence against NHS staff. Anything that can act as a deterrent is a good thing.

We have reiterated time and again how violence and aggression aimed at doctors and other health workers, just trying to do their job, ie. care for people, should be treated in such an appalling way. This is a growing problem which will not go away overnight. Our members should not have to live in daily fear of being attacked.

As some trusts already have CCTV cameras, why has the WAG not used this as a basis for the pilot, so that we would now be in a position to roll them out to all A&E departments in Wales?

And this is about more than just CCTV.

The BMA, giving evidence to the Audit Committee recently highlighted the following action areas;

• 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 lack of relevant information.

• Ownership and Responsibility for staff Safety - ensure that a senior staff member is given the responsibility for staff safety and monitored on that responsibility.

• Training and Communication - ensure that all staff are fully trained, 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 - ensure that patients and healthcare users know that they are not outside of the law while in contact with healthcare professionals, and that those offenders will be brought to justice.

• Police Liaison - to work in partnership to develop a common understanding of how attackers are dealt with.

This focus on CCTV cameras also shifts the emphasis on to NHS staff in hospitals, when violence is a particular problem for lone workers, ie. GPs and health visitors. Measures need to be taken to enusre their protection too.

Wales lags behind when it comes to stroke services

The Royal College of Physicians’ latest report into stroke care services makes for disappointing reading for Wales. There seem to be big geographical differences here, which don’t seem to be occurring in England and Northern Ireland. Has the so-called postcode lottery, seen in drugs and treatment for various forms of cancers, now spread to stroke services? Where you live, should have no bearing on the quality of stroke care you receive.

The report does highlight some areas that have improved, but as is so often the case, there is still plenty more to be achieved, to get Wales just on a par with other UK nations.

Some time ago, BMA Cymru Wales drew attention to the plight of stroke services and patients. In fact, we held a seminar on the issue, inviting Assembly Members to find out more about our concerns. I have to say, rather disappointingly, it was poorly attended by AMs.

No doubt many people reading this blog, will have seen the current TV advert, pointing out the need to act quickly when someone suffers a stroke. That’s to be commended, but we also need to make sure that once a patient reaches hospital, they are able to access the right services. Doctors know only too well how prompt action and the correct treatment can help with rehabilitation and long term damage. That’s why patients should be seen in stroke units up on their arrival at hospital.

Could do better Darling

The Chancellor Alistair Darling’s taxation increase on alcohol by 2%, is a step in the right direction, but to be honest, it really doesn’t go far enough.

We've been campaigning for some time for higher taxes on alcoholic drinks, but crucially, this increase should be proportionate to the amount of alcohol in the product.

Today’s rise announced by the Chancellor won’t necessarily end irresponsible promotional activities like happy hours and two-for-one offers, or the deep discounting carried out by supermarkets. A minimum price for alcohol, which we advocate, would put a stop to such practices, at the same as enabling pubs and bars to better compete with supermarkets.

Since 1997, taxes on wine and beer in the UK have only increased in line with inflation, while taxes on spirits have not increased at all. There is strong and consistent evidence that alcoholic price increases, result in reduced consumption.

Alcohol misuse not only costs lives, it also costs the country many millions of pounds. The NHS spends millions every year on treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences. The UK government has today, missed an opportunity to act on this.

Pressures on NHS bed risks patient safety

Today, we’re highlighting the dangers of cramming patients onto hospital wards, at the same time as the number of beds on wards, are falling.

Because we’re so concerned, we’ve just held a media briefing with Dr Andrew Dearden, Chair of Welsh Council and Dr Stefan Coghlan, Chair of the BMA’s Welsh Consultants Committee.

Figures show that over a ten year period (1997-98 to 2007-08) the total number of NHS beds in Wales fell by nearly two thousand. But, in that time the percentage bed occupancy increased from 78.7% to 82.8%1, which has led to our growing worry for the safety of patients.

Dr Coghlan outlined in the briefing how the NHS is being pushed to breaking point with more patients being treated and despite managerial efforts to reduce the time that patients spend in hospital, the average length of stays, is actually increasing, as the number of beds available for them, is shrinking. This is putting an intolerable strain on staff and causing a great deal of stress and confusion to patients. We certainly wouldn’t be able to cope in a crisis. It is just unsustainable.

The situation has been getting worse during the first few months of this year. A worrying combination of unprecedented emergency admissions, more planned surgery to meet access 2009 targets and so called efficiency savings with pressure to balance the books by the end of the financial year has resulted in unacceptable bed pressures. NHS managers have been holding crisis meetings on a daily basis about where to put patients. We seem to be getting to a point where it’s a case of ‘any bed will do’.

“Hot-bedding” where patients are moved around wards as beds become free appears to be a worrying trend too. Three or more patients could have been in the same bed, on the same day. This constant swapping can cause real confusion and distress, particularly for more elderly patients, who end up not knowing where on earth they are. This makes it very difficult for families visiting, to locate their loved ones, even for doctors to find their own patients. It may not be the best use of a consultant’s time, trying to track down patients and we have heard instances of patients being forgotten about, as they are moved from ward to ward.

And it is the most vulnerable that this impacts upon. The elderly, infirm patients who are most affected by being moved, are also the patients most likely to be moved from wards, to accommodate new admissions. Moving elderly patients can precipitate acute confusional states and general deterioration in their health.

Over-crowding and moving people around hospital wards can increase the risk of contracting and passing on infections, such as C.difficile. Last month, the Welsh Conservatives obtained figures showing that in 2007-08, more than 3000 people aged over 65 contracted the C.difficile infection.

NHS Trust finances could be a possible reason for the decline in bed numbers. There are extra financial pressures on managers at the moment, to balance their books, before the planned NHS reorganisation becomes fully operational in October. And one of the easiest ways of making efficiency savings is to cut bed numbers, regardless of the dire consequences this can have for patient care.

So, the BMA is calling for a change in bed occupancy policy, with less emphasis on dwindling bed numbers, at a time when we have a growing ageing population, who need more long-term treatment in hospitals. Patients, in particular elderly ones, are being put in danger and this must not be allowed to continue.

We also feel it would be beneficial to change the way statistics are collated and reported so that they better reflect what is going on in Acute hospital beds.

It would be good to hear from any members or the wider medical profession, if they've encountered any of the above issues...

Statistics available at http://www.statswales.wales.gov.uk/tableviewer/document.aspx?FileId=1996

1000 Lives Campaign, one year on

So, we’re a year on from the start of the 1000 Lives Campaign and it does seem that progress has been made in the first twelve months, with an estimated 410 lives being saved in that time.

A year ago, we welcomed the initiative and its drive to create safer environments and consistently high standards of care for our patients.

Now, as the Campaign enters its second year, the key is to maintain the momentum and spread the good practice that has been achieved across all organisations in Wales.

Our members will continue to contribute to the Campaign’s aims and highlight areas that require greater focus to make NHS Wales safer for all patients.

We will keep on highlighting areas of concern which doctors believe are having adverse consequences for patient care and clinical outcomes. And this Campaign provides the right background context in which to do so.

BMA Welsh Council Chair features in Western Mail column

This may be of interest to members.

Please take the time to read this column.

Report of visit to BMA Wales Council Meeting 11th March 2009

I thought it might be useful and interesting for members to read a visitor's account of the last Welsh Council meeting, held in March.

This was written by Clare Jenkins, Chair of Powys Division.

"I was pleased to be able to attend the recent meeting of Welsh Council. Gregynog Hall was an interesting choice of location for accessibility and I hope that this will not deter Welsh Council from repeating the experiment in other locations in Wales. However it was disappointing that there was not more interest shown by local members in the ‘visitor’ experiment. Perhaps it would have been helpful to contact local Divisional secretaries to ask them to raise awareness of the opportunity, rather than rely on members noticing a news article in BMA News about 2 weeks before the event. However, as in fact there were places for only 2 visitors, it can be understood that a flood of applicants was perhaps not being sought.

As a past member of Welsh Council I found a definite improvement and more businesslike approach to the meeting, which now lasts a whole day. This allows for a more thorough discussion of items, which were logically grouped on the Agenda. The chairing of the meeting was masterful – humorous but firm and it was good to see that the new responsibilities of membership of Welsh Council were being taken very seriously.

It was also very encouraging to receive approaches from members in regards to creating links with our division. Now that there are no longer divisional representatives on the new Welsh Council I had concern that Divisions would cease to have any relevance in Wales but this meeting has reassured me. There was a report from the Chairman of the Honorary Secretaries Group and I hope that in this way local concerns will continue to be aired at Welsh Council.

There was an interesting discussion on how best to engage the Council members in responding to the various consultations and documents that need to be discussed. Tying in with the new role of membership was the responsibility to have submitted one’s comments BEFORE the meeting so that these could be summarised in the meeting papers. No more reading the papers on the train and producing off the cuff comments at the meeting. This seems to be a very sensible decision, if the new Welsh Council is to really move ahead in its workings, as it will allow time at meetings for more in depth discussion of important items. However, the issue of electronic communications was brought up and it was clear that there was not equity of access to the internet for all members – some areas of Wales still do not have broadband access. This is a point the BMA as a whole needs to take on board when it considers 'electronic only' communication to members.

As a ‘reach out to the members’ exercise this trial is to be commended. The fact that there was poor uptake (although to allow only 2 members would in any case not have made much difference in the event) should not be taken as meaning that there is no interest in the experiment being repeated in other parts of Wales. After all even some members themselves did not make it to the meeting although others made valiant journeys. If there is serious commitment to making contact with ‘grass roots’ members this exercise should be repeated regularly even at the expense of inconveniencing members and secretariat. Once it becomes an established norm, awareness and interest may improve.

I hope that even if Welsh Council cannot face regular trips out into the hinterlands, the principle of allowing visitors will continue for ALL its meetings, wherever located. The dates and locations of all meetings should not only be on the (still desperate) internet but also circulated to all divisional secretaries for local publication to members. Agendas should be on the internet in good time. Perhaps if a lot of interest is shown in a particular meeting the barrier of 2 could be raised, demonstrating that Welsh Council really do want its proceedings to be open to all to scrutinise.

Thank you for allowing me to attend this interesting meeting."

So hopefully having read this, you now feel it would be beneficial to take advantage of the visitor scheme and attend the next Welsh Council which is on May 18th, in Cardiff. We have a number of external speakers attending this;

Dr Chris Jones, Chairman RCT LHB, who is currently working on a project for the Minister for Health and Social Services, called the Primary and Community Strategic Delivery Progamme. He will give a presentation on the new "vision" of Primary and Community Services.

Professor Mansel Aylward who will give a presentation on the work of the Bevan Commission

Dr Malcolm Lewis who will give a presentation on revalidation/relicensing

If you would like to attend please contact Sarah Ellmes, sellmes@bma.org.uk

Blog worth reading and poll worth voting on

Nick Nunn, I applaud you and your blog, you take the words right out of my mouth!

And don't forget, there's still time to vote on our poll on this matter, see the right hand side of this page, let me know what you think.

How big an issue does binge drinking in Wales need to be before serious action is taken?

If ever we needed proof of how big a problem alcohol misuse is becoming in Wales, then this report from the National Public Health Service for Wales surely gives us just that.

Just to give you a taster of what’s in the report;

1,000 people die from causes related to alcohol in Wales each year

Wales has the highest number of 13-year-olds who say they have been drunk at least twice

Those living in deprived areas are three times more likely to die of a cause linked to alcohol than those living in more affluent areas

So proof then that tackling dangerous levels of alcohol consumption is our next big public heath issue.

It’s for this very reason that we want the WAG, either alongside the UK Government, or on its own through devolved powers to bring in tighter regulations around alcohol and the drinks industry.

Some of this centres on the price or “cheapness” of alcohol, making it extremely accessible to those in deprived areas and to youngsters. So we want to see an increase in taxation on alcoholic drinks, with the tax being proportionate to the amount of alcohol in the product. We’ve also been calling for a Licensing Measure to put a stop to the deep discounting of alcohol for sale in places like off licenses and supermarkets.

We’d also like to see research carried out into the measures by which pricing mechanisms can be used in Wales to discourage heavy consumption of products with a high alcohol content.

That’s some of the practical work around pricing and licensing that needs to be carried out in light of this new report from the NPHS.

There is a big role for doctors to play in all of this too, in trying to help change people’s attitudes and behaviour about drink, so that it’s not seen to be so acceptable to binge drink. Coupled with that, there should be more funding for services geared towards treating alcoholism.

These steps won’t change things overnight, but they have to be steps in the right direction surely?

Madeleine, I salute your quest for a smoke-free life!

Moving on a bit from yesterday’s blog but sticking with the smoking theme, since starting my blog I have been trying to make sure I read others and I’ve come across an interesting one, showing the battle faced by a smoker, aiming to quit. Which has made me think about just how tough it must be for anyone who really does want to kick the habit. It’s this ‘habit’ which can make it so difficult for some people, the ritual of lighting up which becomes so ingrained in a person’s routine. Non-smokers sometimes don’t understand how addictive nicotine is.

Thankfully there is a lot of support available for those who do want to quit and effective nicotine replacement products too. Which links in with a study in the BMJ, showing how smokers who may not necessarily want to quit straight away, but are prepared to try to reduce their smoking, are twice as likely to stop in the long-term, if they use nicotine replacement therapy (NRT) to help them cut down gradually. So Madeleine, good luck, stick with the NRT and here’s to a nicotine-free life stretching ahead of you!

If anyone reading this has any tips on how to quit, then feel free to post them on here, or any more help you would like to see made available for smokers trying to give up. And of course I’d love to know what you think about the BMA’s calls for the smoking ban to be extended to include hospital grounds…

Time to stub it on hospital grounds in Wales

On the second anniversary of the ban on smoking in enclosed public spaces in Wales, isn’t it about time it’s extended to all hospital grounds?

The situation with this at the moment is that some Welsh NHS Trusts operate voluntary codes, but these aren’t enforceable by any laws or fines.

The BMA in Wales has campaigned before for smoking to be banned on all hospital grounds. In fact, we called on the Assembly Government to change the law to ensure hospitals were included in the smoking ban legislation, which came into effect two years ago today.

This wasn’t done, and now, more than ever, it seems absurd to have smoking outlawed in places such as pubs and restaurants. But on hospital grounds, where people go to be cured of illnesses, it isn’t. The very reason people visit hospitals is to increase their chances of getting better, not to potentially have their health threatened, by having to fight their way through clouds of cigarette smoke.

This anomaly’s recently been highlighted by North Wales NHS Trust, where security staff reportedly face 3,000 incidents of verbal abuse a year, as they try and enforce a ‘zero tolerance’ policy smoking on Trust grounds.

It seems logical that if it was actually made against the law to light up around hospitals, much of this abuse could be stamped out.

It really is time the Welsh Assembly Government addressed this issue and what better time than now, as we celebrate enclosed public places in Wales being smoke-free for the past two years.

Welsh doctors call for free prescriptions for English patients

On the second anniversary of the abolition of prescription charges in Wales, I now think it’s high time the scheme is extended to English patients. This surely would be the fairest and simplest option, rather than the Department of Health’s plans to extend a list of exemptions.

It seems ridiculous that for two years now patients in Wales have been able to visit their GP, without worry or fear of being able to meet the cost of any subsequent medication needed, when those same patients, who can be just a few miles across the border in England, have to pay an increased cost each year, from today, £7.20 a time.

I know of one person (and there will be dozens more I’m sure) who lives in Dymock, Gloucestershire, just 10 miles from the Welsh border. This person has to take regular medication for asthma, so is adversely affected by being a few miles outside of Wales. This just causes confusion and inconsistency. This individual is also on a low wage, but not “low” enough to be included in the list of exemptions being drawn up. And that’s why I think abolishing prescription charges altogether is the best way forward, just becoming a disincentive to taking essential medication for those struggling to make ends meet.

Scrapping them altogether could have benefits to society as a whole, as well as for individuals. For example, it could reduce hospital admissions, and help people return to work more quickly following illness.

And the argument used by some critics of free prescriptions that millionaires are using them to pick up items like bonjela for free, doesn’t really stand up. Statistics show that almost a third (20.3 million) of prescription items dispensed in Wales are for cardiovascular treatment. A further 19% (11.5 million) are for the treatment of central nervous system disorders. 1

We know that in Wales we have a high number of people with long term illnesses and these figures reflect the fact that more preventative work is being undertaken, with GPs prescribing medicines which are helping people manage their chronic conditions and keeping them out of hospital, reducing the cost and pressure on the NHS. And that’s why I urge health chiefs in England to follow the example set by Wales.

1 Source – Statistics for Wales – prescriptions by General Medical Practitioners in Wales 2007-08 (http://www.statswales.wales.gov.uk/tableviewer/document.aspx?FileId=1864)