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Monday, 28 September 2009

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.



Wrexham Waterworld
CHARGES - £3.20
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

Queensway Stadium
CHARGES - £3.20
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

Plas Madoc
CHARGES - £2.50
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.

Wednesday, 23 September 2009

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.

Tuesday, 22 September 2009

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.

Thursday, 17 September 2009

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.

Tuesday, 15 September 2009

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.

Monday, 14 September 2009

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.

Friday, 11 September 2009

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..."

Thursday, 10 September 2009

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!

Tuesday, 8 September 2009

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”

Monday, 7 September 2009

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.

Friday, 4 September 2009

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.

Thursday, 3 September 2009

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.