Some Good News on World Stroke Day

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

A very welcome development.

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

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

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

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

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

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

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

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

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

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

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

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

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

What Wales needs is a comprehensive action plan on stroke.

Out of Sight: Out of Mind

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

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

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

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

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

Reporting patient safety concerns will lead to better patient care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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