ARM – day two - Chair of Welsh Council addresses conference

Dr Andrew Dearden, Chair of Welsh Council has opened day two of the ARM, in Liverpool.

In his address, Dr Dearden has just delivered an update of BMA Cymru Wales’ work over the last year, outlining the new-look Welsh NHS. He views the last twelve months as a success for the BMA in Wales, in engaging with both the profession and the public as well of course, as representing members.

A packed conference hall loudly applauded at the mention of the Welsh Assembly Government’s commitment to free accommodation for junior doctors, and at the wise and more enlightened approach the WAG has taken "to build a health service free from commercial pressures, free from competition and free from private, profit driven provision."

As Dr Dearden adds "We are also now beginning to see real benefits of political devolution. The health service in Wales remains true to the ideals of its founder, even if they have been forgotten or deemed irrelevant elsewhere".

But, it doesn’t end there. As we know the health service in Wales is far from perfect, and those working within it are facing fresh and difficult challenges. The historic legacy of under funding health in Wales, coupled with higher levels of disease and deprivation, is hard to overcome. That is why the current NHS re-organisation has to work, we can’t afford for it not to. And with proper and constructive clinical engagement, it will.

Our current focus is on the plight of Junior Doctors and Medical Students in Wales which we will be doing a lot of work on over the next year and beyond if necessary.

Dr Dearden told conference: "We will drive home our message to both hospital managers and politicians, that the effective training of junior doctors and medical students is not a luxury – it is not an optional extra, expendable in the face of targets, it is one of the most critical components for the future success of the NHS in Wales and the UK".

Dr Tony Calland, former Chair of Welsh Council, followed Dr Dearden’s address, putting forward a motion on IT in the Welsh NHS - another area where we seem to be leading on (it’s not often that a BMA Council proposes a motion praising Government – a fact that Dr Calland also recognised in his speech!) He states that WAG has taken a thoughtful and pragmatic approach to modernizing medical IT systems, and has worked closely with the profession to develop it – which is the key to its success, I’m sure.

It’s time for a lunchtime break and a quick walk around the Albert dock, preparing for this afternoon’s agenda which includes community care, mental health, safeguarding children and forensic medicine.

More to follow...

Kicking off the ARM with a call to "Look after our NHS"

Day one of this year’s ARM in Liverpool began with BMA UK Chairman Dr Hamish Meldrum’s key address to delegates. The hall’s packed with around 500 doctors from all over the UK.

In his speech Dr Meldrum called on the Westminster Government to “end this ludicrous, divisive and expensive experiment of the market in healthcare in England.” He urged doctors to sign up to the BMA’s “Look After Our NHS” campaign which is gathering examples of how the market is impacting on the NHS. To much hand-clapping, he said there was never a better time to abandon market reforms in England.

In Wales, thankfully we have a Government in the Assembly that has rejected the internal market in healthcare and the commercialisation of the NHS. This has been continued, rightly so, in the recent reform programme.

As I listen to doctors from England who tell me their priority and loyalty to patients and patient care is being compromised by the need to meet tough and arbitrary financial targets, I am grateful to be a doctor living and working in Wales.

The NHS is facing some of the biggest and most serious challenges ever, as we move from a period of sustained growth in resources to one of, at best, stagnation in funding, and at worst, stringency, hardship and even cuts, in our health service.

Although the NHS in Wales has its own challenges, the concerns that I have listened to so far from doctors practicing in England go against the core principles of our health service. The Welsh Assembly Government certainly face serious challenges and criticisms in other areas, but rejecting commercialisation in our NHS is one very important thing that they have got right. Our NHS is and has to remain – Publically Funded, Publically Provided and Publically Accountable.

I will leave you with a quote from Dr Meldum’s address:

“We need to do everything possible to protect the healthcare budget and not concede that swingeing cuts are either inevitable or necessary… The profession is ready to work with whichever governments are in power, to look at the hard choices, to make the tough decisions on the basis of evidence, fairness, equity and trust … We need a whole-system and across-government approach to improve the health of the public, with every citizen involved …Only that way will we slow the inexorable rise in pressure on our National Illness Service and cope with the financial and clinical challenges that lie ahead.”

Watch this space, there’s plenty more ARM coverage to follow...

How BMA membership can get Junior Doctors discounted access to exam revision tools

Following on from my post about the ARM next week, there will of course be many initiatives being announced there, but I thought I’d give junior doctors and medical students in Wales a heads up on one.

BMA and OnExamination are going to be providing members with a 33% discount off OnExamination’s Junior Doctor exam revision resources, being demonstrated at the ARM next Wednesday.

The Junior Doctor revision resources include:
• MRCP Part 1
• MRCP Part 2
• MRCPCH Part 1 A and B
• MRCOG Part 1
• MRCOG Part 2
• MRCS Part A Papers 1 and 2
• FRCA Primary
• MRCGP
• DRCOG
• MRCPsych Paper 1 and 2

As well as the 33% discount now available on Junior Doctor exam revision resources, the same level of discount is also available for Medical Students in Year 1, Medical Student Years 2-3 and Medical Student Finals. This has been coupled with 50% off BNF Prescribing Practice for Medical Students and free access to Medical Student Fresher.

Visit the OnExamination website for more details.

Gearing up for the ARM

I’m really looking forward to the BMA’s Annual Representative’s Meeting (ARM), which starts next week, Monday June 29th.

Most of our members will no doubt be aware what the ARM is, but for anyone reading this who doesn’t know, it is basically where all policy-making decisions for the BMA are decided. It’s held in a different part of the UK each year, with everyone heading to Liverpool this year.

It should be a particularly productive ARM, with many motions being debated including a number of controversial public health and ethical issues such as assisted dying, abortion TV adverts, compulsory immunisation for children and teenage binge drinking.

Dr Andrew Dearden, Welsh Council chairman will be delivering his first speech in this capacity next Tuesday, which will be a key address for Welsh members to watch.

If you are unable to attend, you can watch events unfold online on the BMA website (http://www.bma.public-i.tv) and of course, I will be blogging from there too, so you can keep up-to-date by checking my blog.

Leave our free prescriptions alone!

Once again, I feel the need to defend the Welsh Assembly Government’s policy on free prescriptions, something BMA Cymru Wales fought long and hard to have introduced on the Welsh NHS. The Welsh Conservatives say, if they were to gain power in the Assembly, they would scrap them, bringing in charges for those who can afford to pay the current £7.20 fee English patients currently have to stump up.

Our argument for keeping free prescriptions has been detailed on here before, but I’ll happily outline it again if it means we’ll change the minds of some of the detractors.

Even before prescription charges were phased out, the vast majority of patients were able to avoid paying any way, for a variety of reasons. Where people were having to pay, our members were aware of prescriptions not being collected, simply because of financial hardship. This more often than not affected those whose incomes were just above the level to trigger exemptions on the grounds of low income. In 2001, the Citizens Advice Bureaux published figures showing more than a quarter of people failed to get prescriptions, because of the cost.

Creating a list of exemptions, which is being suggested by the Conservatives, is unfair and unworkable. How do you define what are “serious” enough conditions to trigger these exemptions? All of this would also carry administrative costs to the Welsh NHS, surely, money that would be better spent on making sure patients get access to the medication they eed.

BMA Cymru Wales will continue to lobby to ensure free prescriptions remain in place, for as long as there are people out there, who need convincing of their value.

Will Government finally act on regulating the sunbed industry?

More support today for the BMA’s calls to get the tanning industry better regulated. The independent government advisory committee Comare (Committee on Medical Aspects of Radiation in the Environment) says the current system, where the industry is self-regulated, is inadequate on public health grounds.

The committee’s making several recommendations to Government, many of which we’ve been wanting to see happen for a long time.

These include;

Preventing the use of sun beds by children
Ensuring that sun bed users are supervised
Ending the use of coin-operated machines

The question is, will the UK Government act on these recommendations and actually finally do something about regulating the sunbed industry properly?

BMA guide to Welsh Hospitals for Foundation Year one Doctors 2009 – your help is needed

BMA Cymru Wales has been producing a guide to Welsh Hospitals for F1 Doctors for several now years. It provides information about life as a F1 doctor working in Wales and is really well valued by final year students making decision about their future employment. The guide also gives the BMA vital information about living and working conditions in each of the hospitals in Wales, enabling us to work with Trusts to resolve any issues raised.

This year we are inviting current F1 doctors working in Wales to complete the survey online.

The closing date for completed surveys is Monday 6th July 2009.

The survey is sent to all F1 doctors in Wales and forms the basis of this guide, which is due to be published in October 2009. So your contribution is extremely important to us and I would just like to take this opportunity to thank you for your contribution.

And here, perhaps, is the best bit - by completing the survey you will be entered into a prize draw to win an iPod Classic 80G!

Welsh GP leader's LMC speech - a new NHS Wales fit for patients, not managers

This year’s UK Conference of Local Medical Committees is currently underway at BMA House.

Dr David Bailey, Chair of GPC Wales has just delivered his speech to delegates, detailing the forthcoming priorities for the newly reformed NHS Wales.

Here are some of the key points from the speech...

Dr Bailey's outlined how a reorganised NHS Wales needs to be "fit for the people who use it, not the people who manage it" and how ten years of devolution have left all four UK nations with very different healthcare systems.

"In Wales we have avoided the commercialisation of health for shareholder profit and we still have an NHS free at the point of sale. And that is to the credit of Wales and the Welsh government.

"However we still have a GP workforce where incomes are lower and falling faster than England, where recruitment of trainees is falling – two things possibly not unrelated - and where treating the highest levels of disease prevalence in the UK is still under resourced. These are all things GPC Wales has to, and will, address as NHS Wales is reorganised."

And it is this reorganisation that Dr Bailey reckons poses the biggest challenge for Welsh GPs in the coming year.

"Eight organisations combining the old trusts and Local Health Boards and eradicating the purchaser provider split – at least in secondary care – will be tasked with delivering healthcare for the people of Wales. These are the organisations that GPs, who are still independent contractors, will have to engage with.

"There will be opportunities. The aim is to move care and resources into primary care to deliver better and more responsive services to our patients closer to their homes, avoiding the hazards of hospitals, and providing a personal service with continuity of care. That’s what Welsh GPs want to do and that’s what our patients, I believe, want of us. They want us to coordinate health and social care in their own homes, they want continuity and to be able to trust a doctor they know. They want good preventive care and to be involved in managing their chronic health problems.

"But, just like everywhere else in the UK, the primary care sponge is full. Give us the resources and – using the mechanisms in the GMS contract - we can deliver, but resources there must be."

View the full conference agenda

EWTD deadline looms closer but NHS Wales seems no closer to being ready for it

No surprises in this story from the Western Mail, yet another looking at the WAG’s (un)readiness for the implementation of the European Working Time Directive this Summer. For a quick recap on EWTD, the position is that come August, junior doctors should not be working more than 48 hours a week.

The surprise here actually comes in the estimate of how many junior doctors the Government predicts will soon be working on non-compliant rotas – 6% out of 600 in Wales. I’m not quite sure how that figure is arrived at, considering not so long ago, the Auditor General for Wales found that more than half of junior doctors in Wales were working more than 48 hours a week.

A real concern for us, and it should be a massive one for patients too, focuses on hospitals which may bring in rotas which meet EWTD compliance, but in practical terms, are unworkable and could jeopardise the safety of both NHS staff and patients.

In the longer term, it will also have a knock-on effect for the future doctor workforce of the Welsh NHS, with crucial training and educational activities being missed, just to provide the basic cover for patients.

We have been warning the Welsh Assembly Government about this for many years now, so it’s a shame that we’re in a position where we are just weeks away from EWTD coming into effect, yet the Welsh NHS seems to be light years away from being ready for it.

End to free prescription anomaly

Congratulations to the Welsh Health Minister on ending this discrepancy in the WAG’s free prescriptions policy.

Despite patients in Wales being exempt from paying £7.20 for their prescriptions for the past two years, anyone picking one up at a hospital in England still has to pay. This of course unfairly penalises those who have no choice but to receive treatment across the border.

Thankfully, come the Autumn, this situation will be a thing of the past. Now all we need is for England to fall in line with the rest of the UK and scrap prescription charges.

Government targets interfere with the battle against superbugs

I want to highlight here a new report by the BMA which focuses on the war on healthcare associated infections (HCAIs), or as they are perhaps more well known - ‘superbugs’.

The report illustrates very well how we’ll never win this battle, unless long-term strategies are introduced. Short term solutions like alcohol gel, dress code and deep cleansing must be backed uo with sustainable evidence-based improvements that will protect more patients in the future. Without a change in direction, the risk to patients caused by HCAIs and the burden on our NHS are set to continue.

‘Tackling healthcare associated infections through effective policy action’ calls for a range of measures to minimise the spread of infection and strong governmental commitment focusing on long-term policies that tackle patient throughput and high bed occupancy. It’s not enough any more for politicians to announce new initiatives that are just sound bites. Genuine patient safety comes from embedding long-term strategies to tackle superbugs.

The report says that overcrowding and understaffing in the UK healthcare system adversely impacts on infection control practices, including decreased hand hygiene, increased movement of staff and patients, and worse staff to patient ratios. These problems can only be addressed with strong organisational support that underpins the effective functioning of healthcare teams.

With an ageing population and advances in medical technology and treatments, more patients are being treated than ever before and many are increasingly vulnerable to infection. Infection control is the responsibility of all, from the highest level of hospital organisation and management, to healthcare professionals, patients and visitors.

Key areas for action outlined in the report include:

• Reducing bed occupancy rates should be considered a priority in the development of policies relating to the number of available beds, admissions targets and bed management policies.
• Effective workforce planning to ensure adequate staffing to match workload.
• Dress code policies should be evidence-based with emphasis on the appropriate use of disposable protective clothing (eg gowns and gloves) when healthcare staff are exposed to potential contamination.
• Adequate resources should be provided for thorough everyday cleaning with an emphasis on cleaning high-risk near-patient hand-touch sites.
• The introduction of screening policies should be evidence-based and take into account the practical and cost implications associated with the isolation of patients, visitors and staff who are carriers.
• Compliance with hand hygiene protocols should be facilitated through education, motivation and improved access to hand washing facilities.
• Strategies need to be developed for optimal antibiotic use.

Much of this was also raised by BMA Cymru Wales, in a media briefing we held earlier this year, which we also blogged on here.

I don’t doubt that hygiene, hand-washing and antibiotic policies have extremely important roles to play, but if we want to reduce the spread of infections we must put safety in front of political targets. With many hospitals already working at full capacity, this will only get more pressurised as winter arrives. The pressure to turn around patients too quickly and the lack of adequate isolation facilities create critical challenges to maintaining high quality patient care. We want safe, timely care and treatment, not just fast care.

BMA Cymru Wales at the Urdd Eisteddfod – unearthing future medical talent

I couldn’t really let the opportunity pass without making mention of BMA Cymru Wales being at the recent Urdd Eisteddfod, held in Cardiff Bay.



As part of our work looking to the future workforce of the NHS in Wales, we had a stand at the Urdd, where youngsters could get advice and information on pursuing a career in medicine. We even gave them “hands-on” experience of surgery, by donning scrubs and performing a “life-saving” operation on Mr Urdd. And judging by the dexterity of most children there, I think we can rest assured that NHS Wales is in safe hands!

Junior doctor worries are a worry for us all

I think we are all aware that there a significant number of junior doctor vacancies in Wales. BMA Cymru Wales has been working with the Deanery in Wales to try and improve this situation and attract junior doctors to come and live and work here.

The effect of vacancies will be exacerbated in August with the introduction of the European Working Time Directive. The adverse consequences of unfilled junior doctor posts and its impact on the ability to deliver patient care cannot be overestimated.

I didn’t, however, appreciate just how bad the effects are being felt NOW, until I met with some junior doctors in South Wales, and heard some worrying concerns about many aspects of their training and development. They highlighted a range of issues, only some of which I’ll outline here:

A&E on-call rota
I was told of instances where F1 and F2 doctors are merely acting as clerking machines, which isn’t allowing for teaching on post take ward rounds. Rotas are also being used as a fast-track, in order to maintain the four hour A&E targets set by but this doesn’t provide opportunities for juniors to learn.

Rota gaps and lack of cover on wards
I also heard of how F1 doctors are being left without senior support on wards, for days at a time. Rota gaps are so widespread within the majority of specialities, there isn’t any advertising in advance for any known gaps and I was told that whilst medical rotas appear to be compliant on paper, that doesn’t actually translate into reality.

Locum cover
The meeting highlighted how there’s no real effort made when it comes to finding locums, instead juniors are being called back from annual leave to cover, with locum rates here being apparently half those in England; this is no way improve morale or make Wales the premium destination for junior doctors, especially when it is undertaken in a climate of bullying and intimidation.

Nurse Practitioner intimidation
Anecdotal evidence was also relayed to me about how Nurse Practitioners are prescribing medications and fluids and then demanding that doctors sign for them, even though the Nurse Practitioners are meant apparently to be independent prescribers. Junior doctors also felt that some working arrangements left them restricted and limited in their exposure to the range of clinical experience necessary for their training, especially when managing problematic patients.

I could go on, but I think this highlights the sort of issues facing junior doctors in Welsh hospitals. BMA Cymru Wales is so concerned about all of this, it is considering an initiative led by Welsh Council and the Welsh Junior Doctors Committee to take these matters up with the relevant employers.

Unless urgent action is taken to address these matters, our ability to attract the best to Wales will be thwarted. And that would be a shame as the direction of travel of the WAG and the Health Minister, Edwina Hart, to get back to the core values of the health service is something the BMA welcomes. It is a system that doctors should be queuing up to be a part of. Let's all get on the case of the problems, have more ambitious aspirations and ensure the patients of Wales receive the high standard of services they deserve.

Expect to hear more about this over the coming weeks, this blog post won’t be the end of the matter!

If you have concerns as a doctor working in Wales, or a patient receiving care here, over any of the issues highlighted in this post, then please tell BMA Cymru Wales about them! You can do so just by leaving your comments on this blog post, anonymously.

Compulsory vaccines aren't the answer to preventing another measles outbreak in Wales

I'm glad to see the issue of the measles outbreak currently affecting Wales being discussed on other blogs, as the more we can do to raise awareness about it, the better.

This massive increase in the number of cases of measles in children in Wales is a huge concern for doctors and parents alike. Measles can be deadly, so it is vital youngsters are vaccinated against the disease.

The way in which some of the media dealt with the unfounded assertions about the MMR jab several years ago was extremely unhelpful and the ramifications from it are still being dealt with today, as demonstrated with this current measles outbreak.

Now is the time for a concerted public awareness campaign led by the Welsh Assembly Government, that dispels any myths and misunderstandings about the MMR jab, so immunity levels can be raised to the levels needed to protect our children from this sometimes life threatening infection.

Some people want to see compulsory vaccines brought in as a way to reverse the very low rates of immunisation. The BMA does not regard that to be appropriate. Parents must be able to have a choice. So long as parents have access to the necessary information and facts, they will continue to make the right choices for their families, as they always have done. Doctors working in partnership with their patients, is the best way to access the appropriate healthcare and this is no less important in the field of immunisation.