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.

Action needed now to stop NHS Wales becoming unsafe for staff and patients

Unless urgent action is taken to plug the gap in the shortage of middle grade doctors, the NHS in Wales could become unsafe both for staff and patients.

The problem‘s been highlighted this week within Hywel Dda NHS Trust, where 62 posts remain vacant.

But this situation is by no means isolated to Hywel Dda, with Abertawe Bro Morganwg Trust having had to move some specialist services because they were inadequately staffed. Similar problems are also affecting North Wales too.

We are facing unprecedented levels of a lack of middle grade and junior doctors right across Wales, which is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future.

There are a variety of reasons for this shortage, one being that Wales does not top the list of places where many junior doctors desire to work. Also, changes to the rules regarding immigration have caused problems with recruitment across the whole of the UK, not just Wales.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas. This is compromising consultants’ ability to deliver routine daily work and there is no evidence that hospitals are adjusting services to take these shortfalls into account. Inevitably, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers really need to address this now, working with clinical colleagues.

These problems come as no surprise however to us at the BMA, having predicted that these shortages would happen at some point. That is why we have, for some time now been trying to meet with representatives from the Welsh Assembly Government, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation.

BMA Cymru Wales has also worked in partnership with the Wales Deanery for Postgraduate Medical and Dental Education, to produce a DVD for students, giving an invaluable insight into medical training here.

The aim of the video is to promote Wales as a primary destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here. However, the positive effects of this will not be seen immediately.

The initiative to provide free accommodation for F1 doctors has been welcomed by BMA Cymru Wales and has had some impact. Yet, I think far more effort should have been put into anticipating and planning for the current shortages, especially the impact of the European Working Time Directive which has been known about for more than 13 years! Whilst it is very late in the day, I urge the Welsh Assembly Government and employers to focus on the actions we have been highlighting for some considerable time. I do not think sufficient, co-ordinated efforts to recruit and retain doctors to Wales has been made.

While in the short term, we have to have contingency plans put in place as soon as possible to ensure the safety of both NHS staff and patients, we need far more sustainable solutions if NHS Wales is to deliver and maintain the quality and capacity of services the people of Wales deserve.

Stroke patients in Wales deserve better

Having come across this latest research into acute stroke care centres, it only serves to demonstrate just how much Wales continues to lag behind other countries, including England and Ireland and how vital it is that Wales not only starts playing catch up, but that it also is at least on a par with other countries.

The research highlights how having dedicated specialist stroke centres greatly improves the acute and long-term care of patients. Being treated in such centres can double a patient’s chances of surviving a stroke and not sustaining any long-term damage. In England, nearly all hospitals have these units, yet only half of Welsh hospitals do.

The NHS reorganisation provides a golden opportunity for the new Local Health Boards to each establish specialised stroke units, not necessarily for every hospital to have a unit, but for patients to be within a reasonable travelling distance of a facility. Someone getting the best possible stroke treatment shouldn’t depend upon where they live, as seems to be the case. A patient suffering a stroke in Cardiff, close to the UHW is undoubtedly in a better position than someone in a more rural area.

Funding is a big factor in the gap between stroke services in Wales and other countries. Just taking the rest of the UK as an example, England has earmarked £105 million and Northern Ireland has set aside £14 million over three years, with a further £9m available. That compares to the Welsh Assembly Government’s £2.5 million per year for three years. And England and Northern Ireland were already ahead of Wales with regard to the quality of stroke services.

The Stroke Services Improvement Programme is visiting all parts of Wales over the summer, hopefully providing an overview of service gaps and giving indications as to what level of funding is required.

The Health, Wellbeing and Local Government Comittee is currently carrying out an inquiry into stroke services. Two of the committee’s main Terms of Reference include looking at the availability of specialist stroke units in hospitals across Wales and geographical variation in these services and the resources devoted to stroke services in Wales. So hopefully, recommdendations will be made and more importantly acted upon, which see stroke patients in Wales getting AT LEAST the same level of treatment as elsewhere in the UK. And any recommendations made in this inquiry need to be acted upon sooner, rather than later.

Wales is right to opt out of swine flu helpline – for now

Looking at some of the media coverage over the weekend and the past week in fact, it only serves to reassure me that Wales is right so far, to opt out of the National Pandemic Flu Service, now operating in England.

The Chief Medical Officer for Wales, Dr Tony Jewell, attended a meeting of our GP committee last week to keep us up-to-date with what’s happening and it was agreed by everyone how well GPs and primary care are coping at the minute, as well as our hospitals - hence why we don’t need to be signing up to the flu service just yet.

The focus in Wales is to ensure that cases of swine flu, or potential cases are clinically managed and advised. This is likely to best achieve what everyone wants - clear advice and guidance, the most accurate diagnosis, and the right treatment at the right time, but not to be treated unnecessarily, or to be treated for the wrong condition.

It really is important to keep perspective on this as I mentioned here last week and to not be sucked in by the scaremongering which seems to be going on in certain areas of the media. Despite an increase in cases of swine flu in Wales, the number is still at a level that would be considered normal for flu in the winter, in others words, nothing GPs and our helath services don’t deal with every year.

Tamiflu, the ant-viral drug being prescribed for swine flu is not without side-effects, such as nausea, insomnia and irritability. As most people who’ve had swine flu report it as being no worse than a bad cold, for the otherwise healthy the treatment maybe worse than the disease and symtomatic treatment alone is all that is necessary. That doesn't of course apply to those in the at risk groupS, where Tamiflu would be indicated. But everyone is different and the decision to treat should rest between patient and doctor, as always.

What we need to ensure in Wales, is that the right decisions are made by independent and experienced health professionals, as is happening currently. That's not to say that things won't change and use of the "Flu-Line" will be welcome. However BMA Cymru Wales has faith in the Chief Medical Officer to make the right decisions for the people in Wales, at the right time, as the Chief Medical Officer and the Welsh Assembly Government has faith in GPs in Wales to deliver for their patients.

Employers need to keep us informed as swine flu spreads, to stop NHS Wales from grinding to a halt

As swine flu continues to grip the UK, everyone is looking to the health of the public, which is of course only right. I think there is also though an urgent need to look at the implications for health staff and how services can be best managed to ensure they can cope with the demand. There is an enormous amount of planning and logistics going on behind the scenes to "keep the show on the road", but sometimes it is the practical matters that need to be clearly communicated - and that make all the difference. Some of the issues raised by BMA Members that need clarity and that we are raising with Welsh Assembly Government and employers include:

Medical rotas

I know that, while many medical rotas are EWTD compliant on paper, they rely on doctors’ good will to undertake additional duties for their effective operation. As such there is a real risk that these rotas will become inoperable due either to sickness among the doctors on the rota, or those doctors being redeployed to other duties. When (or hopefully in advance of) these rotas are on the point of falling apart, who makes the decision to either suspend their normal operation or combine them with other rotas or otherwise? Clarity is needed.

Routine clinics

Routine clinics may need to be cancelled, either from general population illness or patient reluctance to attend (particularly those clinics serving patients who may be immuno-compromised). How are medical staff to be redeployed, inevitably at short notice and for short periods, and who will make those decisions?

Reporting arrangements

The reporting arrangements (who to telephone, etc) when medical staff become symptomatic (and with whom to discuss their symptom severity) do not seem to be that well known, together with consequential advice on recommended absence periods before returning to work. How are employers communicating this message?

Medical staff in high-risk groups

Appropriate advice for medical staff who may be in high-risk groups (especially those who are pregnant) is as currently topical for them as for the general population. What steps are employers, through their occupational health services or otherwise, taking to risk-assess these members of staff and to deploy them to appropriate duties?

BMA Cymru has raised these issues and asked that they be addressed as a matter of urgency. We have also asked for confirmation that comprehensive guidance on all the above points as well as other key information is sent to all members of staff - and is consistent across all organisations in Wales. For medical staff, this must include GP contractors, all part-time and locum doctors, and medical students on clinical placement.

It is at times like this that everyone has to pull together, to ensure things run as smoothly as possible - but that will only happen when essential and often basic information is communicated in a timely, effective and consistent manner to those on the frontline - so that there is no confusion or time wasted over what exactly are the procedures to be followed. This will help NHS staff in Wales who do an outstanding job day to day, and pull out the stops further at times like this, to best protect themselves and so better serve the people of Wales.

Aiming for some perspective on swine flu

I thought it about time that I addressed the issue of swine flu here, having perhaps unintentionally avoided doing so, so far!

It is understandable that people will be worried when they hear about the potential number of fatalities that may arise due to the pandemic. However, it should be remembered that these are worst case scenarios, to enable government to plan.

I would urge everyone to follow the recommended advice and telephone their doctor or NHS Direct, rather than physically going to the surgery, if they have symptoms and are concerned.

In most cases, it will be a mild illness and the vast majority of people will recover quickly by taking paracetamol or ibuprofen, and drinking plenty of fluids. Anyone who is not recovering quickly or who is in a more vulnerable group, for example young children, pregnant women, or those with underlying health conditions, should get extra advice as a small number will need more intensive treatment.

The message we need to get across is it's a pandemic flu - this is new, we haven't seen this before and yes, most of us will probably catch it.

It is important to remember that every year there are deaths from complications of seasonal flu; this is unfortunately inevitable with any strain of influenza. But following the recommended advice should minimise the risk.

Simple but effective hygiene measures such as frequent hand-washing can also help. Cover your mouth with a tissue when you cough or sneeze, then put the tissue into a bin and remember the phrase which is fast becoming a mantra amongst healthcare professionals – “catch it, bin it, kill it!”

The latest information from the Welsh Assembly Government on swine flu can be found here.

Candid evidence on sunbeds gives more support to our fight for regulation of the industry

The Assembly’s Health, Wellbeing and Local Government Committee started hearing evidence yesterday into its inquiry into sunbed use in Wales. And it was certainly powerful evidence for the case FOR regulating the industry.

The mother of teenager Kirsty McRae who suffered 70% burns after using a coin-operated sunbed spoke to the committee of how worrying it is to not know what underlying damage may have been caused to her daughter’s skin, having been exposed to such a substantial dose of UV rays at a very young age. And the 14-year-old was able to use the sunbed without her parents’ knowledge and without anyone checking her age, because the very nature of these coin-operated machines means no members of staff needs to be present.

It’s partly because of cases like Kirsty’s that the committee is holding this inquiry, but it’s a shame that such extreme incidents have to happen, before even an inquiry is held, let alone action taken. As readers of this blog will know only too well, BMA Cymu Wales has campaigned for the tanning industry to be regulated for many years and in our evidence to the committee this is exactly what we’ll be calling for. We really can’t have any more repeat cases like Kirsty’s.

Health Minister’s decision to extend free accommodation for junior doctors indefinitely is great news

It’s been confirmed this afternoon by the Welsh Assembly Government that all first year doctors training in Wales will now benefit from free hospital accommodation INDEFINITELY. This really is great news.

Most junior doctors reading this will no doubt be aware that Health Minister Edwina Hart had previously agreed to extend the provision of free on-site housing for F1 training grade doctors in Wales, until summer 2010. Well, this will now continue for the foreseeable future.

The decision follows the recommendations by an Accommodation Review Group (with strong representation by BMA Cymru Wales) supported by collaborative discussions between BMA Cymru Wales, the postgraduate deanery and the Welsh Assembly Government.

After the requirement for pre-registration doctors to be resident at a hospital was removed from the Medical Act last year, it led to protests by medical students outside the University Hospital of Wales, in Cardiff.

Without this free hospital accommodation, its estimated there would be an additional cost to newly-qualified junior doctors of around £4,800 a year, on top of average student debts of £20,000.

So I do think this decision demonstrates the Welsh Assembly Government's commitment to value the role of junior doctors in the NHS and will help to ensure Wales becomes the destination of choice for medical training. It is testament to the collaborative working between the profession and government as NHS Wales returns to the core principles on which the health service was founded.

The minister clearly recognises the importance of valuing junior staff in Wales. We have severe shortfalls in posts in Wales and this will go some way towards creating the culture which is necessary to attract the best medical talent for the future. This, associated with a number of other initiatives to improve training opportunities and academic medicine and research programmes, will bode well for the future of training in Wales and ultimately for Welsh patients.

BMA Cymru Wales will now continue, via the Accommodation Review Group, to ensure the quality of accommodation for junior doctors in Wales is improved to meet at least basic standards and to press for accommodation that does not, to be addressed as a matter of urgency.

Reminder about GMC Licensing campaign

I thought it important to bring to members’ attention the launch of the next phase of the GMC’s licensing campaign, called ‘Licensing: it’s time to decide’.

The GMC’s been asking registered doctors to confirm whether they wish to hold registration with a licence or registration without a licence when the scheme begins on 16th November 2009.

Having spoken to people in the GMC in Wales, apparently more than half the doctors on the medical register have now confirmed what they would like their status to be from November. So the focus of the next phase of the campaign is on those who’ve not yet made their licensing decision. A letter going out to these doctors over the next few weeks will ask them to confirm their choice before Friday 14th August, so time is fast running out.

There is also a new website called Licensing help, which you might find useful to take a look at. It features cases studies of doctors in different professional situations, as well as support from senior figures within the medical profession, who’ve already made their licensing decisions.

I filled in and sent off my reply indicating my decision after the first letter I received and I have to say it was a painless process but will be a more difficult decision for some, than for others. However, it is a decision we all have to make.

Last chance to have your say and be in with a chance of winning an iPod

Just to remind all F1 doctors in Wales about this blog post.

We would like you to complete our online survey for BMA Cymru Wales' 'Guide to Welsh Hospitals for F1s' publication. In doing so, you will be entered into a draw to win an iPod Classic 80G. The closing date has now been extended to Monday 13th July.

ARM – day four – rounding off with occupational health, tobacco and alcohol debates

To kick off the last session of the BMA’s 2009 ARM conference, members looked at the topic of occupational health, something which has been a pertinent issue at BMA Cymru Wales recently. We’ve been seeking assurances that the future of the Primary Care Support Service (PCSS), which is the ONLY occupational health service for doctors in primary care, will be secured during the NHS reorganisation agenda.

Next – on to motions on the environment, calling on the BMA to do more to highlight the global health risks associated with climate change and to reduce our own carbon footprint. We then turned to the important public health issues of nutrition, exercise and obesity, an area in which Wales faces considerable challenges if we are to address them, particularly childhood obesity. Motions calling for more local recreational facilities (swimming pools, cycle routes etc) remind me that when I get back I must find out how Dr Dai Lloyd AM’s proposed Measure on playing fields is getting on.

The HPV vaccine sparked a valuable and lively debate with conference deciding that the roll-out of the vaccine should be extended to boys not just girls, and that it has been a missed opportunity to vaccinate against other diseases such as genital warts.

Also a subject with high prevalence rates in Wales: drugs and addiction. The topics covered by this set of motions call for minimum unit pricing for alcohol; clearer labelling; a ban on alcohol advertising in the media and the redirection of revenue into prevention and rehabilitation programmes. These motions passed UNANIMOUSLY.

Tobacco also generated a good discussion with motions proposed for all forms of tobacco advertising to be banned, including at the point of sale and another calling for cigarette vending machines to be restricted.

After four days of rigorous and impassioned debate, conference draws to a close and its time to return to Cardiff. The ARM has set BMA policy and determined many of the issues that we will be working on for the next twelve months.

For anyone who wants to see a full webcast and results of the motions debated this week click here.

ARM – focus on student finance/debt

And so to yesterday afternoon’s session of the ARM.

We heard the reports from chairs of the following branch of practice committees: general practice; private practice; staff and associate specialists; medical students and junior doctors.

A number of issues within those professions were debated. Conference was treated to a notably lively and impassioned debate on student fees. This is something the Welsh Medical Student Committee (WMSC) has been working on in recent months following the Assembly Education Minister’s proposals to re-focus higher education in Wales.

I know that the Chair of WMSC, Elliott King, has spent many hours considering the implications of the proposals for medical students in Wales and along with the Committee has crafted BMA Cymru Wales’ response to this, at the same time as sitting his own final year exams. I’m looking forward to welcoming Elliott back as Dr King next term given his recent finals success. Congratulations to Elliott and all those who’ve passed their exams.

Conference heard from students who will be graduating with a crippling debt of more than £30,000.

The important area of medical education and training for Junior Doctors also delivered a lively debate. The mention of EWTD, working patterns, rota gaps and student/teacher ratios were met by jeers from fellow Juniors and other delegates. Again the issue of free accommodation for Junior Doctors was discussed. I wonder just how long it will take other nations to follow Wales lead and recognise the value of this important policy.

We’ve had the recommendations, now let’s see action on violence and aggression against NHS workers

Away from the ARM briefly and I’m really pleased to come across this story .

I, along with a GP member of the BMA in Wales gave evidence to the Assembly Audit Committee earlier this year, stressing the very points the Audit Committee has made; namely that not enough is being done to tackle this very real, worrying and growing problem for frontline NHS staff. I do fully acknowledge that some progress has been made in recent years, but not nearly enough, particularly when it comes to prosecuting anyone who is verbally or physically abusive to healthcare professionals - this needs to be properly addressed by the new LHBs in Wales - such that they set a clear line in the sand at their inception.

I would be more than happy, as the committee recommends, to work with Welsh Assembly Government to consider options for tough new legislation; and develop further some of the following action areas highlighted:

• A register of violent patients: allowing doctors, nurses and other healthcare personnel to 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 staff are encouraged to report incidents of violence and aggression and that senior staff take responsibility for staff safety and comprehensively monitor it.

• Training and Communication - ensure that all staff are fully trained, are aware of the mechanisms to report physical or verbal abuse; and clear guidelines are promoted to raise awareness with staff - and deter violent and aggressive acts by patients

• Staff Support - ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident, including through any legal processes that may be pursued.

And if any of our members reading this have been a victim of violence and aggression at work, please let us know.

ARM - day three - medical ethics

So, to the motions on Medical Ethics which saw some of the liveliest debates in ARM history - not surprising I guess, given the content of the motions and the fact that they apply to all branches of the profession across the UK.

Opening this section was Wales’ own Dr Tony Calland, Chair of the BMA Ethics Committee, who outlined the issues that the Committee continues to work on: top-up payments; pandemic flu; presumed consent; compulsory vaccinations; assisted dying and Clause 152 of the Coroners and Justice Bill, which relates to the sharing of patient records (after a successful campaign the BMA recently managed to get this clause removed from the Bill).

On to the motions:

The first relates to spiritual care in the NHS – it follows this story. The motions which passed recognised that the NHS is committed to providing spiritual care to patients and noted guidance from the GMC on the inappropriate discussion of faith issues. Faith is obviously a sensitive and highly personal subject which would explain the heated debate which followed. While recognizing the importance of faith as a part of holistic health care, conference fell short of supporting doctors initiating the issue with patients.

Next up, a motion objecting to the proposed use of TV advertising for abortion services. The motion, proposed by the Yorkshire Regional Council, stated that the adverts will give the wrong message to young women and promotes sex as a values-free activity with a quick medical fix. For many different reasons, the motion fell and in my view, rightly so. It is important that patients receive as much information as possible, particularly women in a situation where they have to consider the complex and distressing decision of whether to continue with a pregnancy or not. As doctors, we have a duty to ensure that our patients have as much information as possible while exercising their right to choose.

Finally in the Medical Ethics section: assisted dying. This motion called for those people accompanying the patient in an assisted death, but not actively participating, be exempt from prosecution; and for patients who are terminally ill but who have full mental capacity to be allowed to make a choice on assisted death. Baroness Ilora Finlay spoke eloquently against this motion drawing on her particular expertise; and indeed both parts of the motion fell – although it was an extremely close vote with very convincing accounts from both sides.

So far it’s been a highly interesting, topical and emotive session.

More to follow...

Put children first in the fight to reduce health inequalities

Another motion up for debate yesterday at the ARM focused on safeguarding children and their futures.

Delegates are calling on the Welsh Assembly Government to put youngsters at the heart of every one of its department’s priorities, for the next two decades, to give ALL children the best start in life.

One way of dong this could be to increase the number of school nurses in Wales and for these nurses to also take responsibility for public health in schools.

With the measles outbreak which is sweeping through Wales at the moment, there has never been a better time for the WAG to honour its promise, laid down in the One Wales manifesto, to provide a minimum of one family nurse per secondary school by the end of the Assembly term.

I think School Public Health Nurses could have played an integral part in helping to prevent the current measles epidemic from spreading as much as it has by providing advice and guidance to parents.

We need to ensure ALL children are given the best possible start in life and where they go to school can have a big impact on this. That’s why, in the most deprived areas of Wales, we need to transform schools in to safe havens for those youngsters from disadvantaged backgrounds.

Very pleasant walk around the Albert dock by the way, shame I didn’t have my camera with me to take a few scenic shots to share with you all on here!