Less talk, more action!

First Minister Rhodri Morgan, has voiced his fears for a “toxic generation” of children who play computer games and eat junk food.

I share his concerns, and fear that we are in danger of raising a generation of children burdened with long term chronic health conditions. Soaring rates in obesity have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers.

Small changes to a daily routine can make a real difference. Just getting children into the habit of walking to school has environmental benefits, and helps with the fight against childhood obesity. Teaching children at an early age about the advantages of a healthy lifestyle often means that they will continue this into adulthood. I’m not saying it’s easy, but it is vital that we act without further delay.

In order to achieve a real improvement for the future health of our children; parents, schools, health professionals, the media, food manufacturers, and the government all have an important role to play.

We need real action from the Welsh Assembly Government on what is going to be done to reverse this growing epidemic. What do you think?

Option 7 campaign extended

BMA Cymru Wales has decided to extend the Option 7 campaign which is aimed at improving the lives of junior doctors in Wales.

We have taken this decision due to the increasingly alarming picture which has emerged since we launched the campaign in July this year.

Junior doctors have been afraid to voice concerns for fear of repercussions. I want to re-iterate the message that the option 7 phone line is completely confidential. If you are experiencing a problem with insufficient locum cover, intimidation, lack of training opportunities or anything else, please do contact us.

Together with BMA Welsh council chairman Dr Andrew Dearden, I have been meeting with the chairs and chief executives of the new NHS health boards in Wales where we have been offering support to employers to resolve the problems highlighted, and have been drawing up an action plans to resolve these problems. We have also met with many junior doctors to really get to grips with the issues that we are faced with.

The types of problems that have been reported to us will not be tolerated. It is vital that you come forward so we can put an end to what could be affecting careers and patient safety.

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.

And follow the campaign updates on Twitter.

The postcode lottery strikes again

The Healthcare Inspectorate Wales, the Wales Audit Office, Estyn, and the Care and Social Services Inspectorate Wales have today published a worrying report on the state of Mental Health services for children and young people in Wales. This is the first time that all four bodies have come together for a service review, which highlights the seriousness of the failings in the service provision.

Although acknowledging recent improvements including the introduction of primary mental health workers who support professionals, such as GPs and school nurses working with children and young people, the report also brings to light those areas in dire need of improvement - especially stressing the variation across Wales in the availability and quality of services. Unfortunately we know all too well that a postcode lottery is a common problem across the board of service provision.

The report also found that Wales is the only place in the UK with no specialist mental health services for children under age five. Why is Wales lagging behind the rest of the UK again?

The Health Minister responded that the findings are "out of date" and "do not reflect wider improvements". However, despite the improvements already made, it is clear that there is a long way to go in improving services for children and young people suffering with mental health conditions. It is time that we stop failing and start helping the young vulnerable children whose lives could be dramatically improved by an early intervention. Let me know your thoughts on the findings.

Minimum price demand on alcohol –in the news again

I'm pleased to hear that Social Justice and Local Government Minister Dr Brian Gibbons is in discussions with the Scottish Government regarding their plans to introduce legislation on the minimum pricing of alcohol, and has called for action in Wales saying we should follow Scotland’s example.

Although we do not have the powers in Wales to formulate similar legislation yet, I hope this is something that we will see progressing soon. The BMA in Wales has campaigned on alcohol issues for years, and we remain committed to finding practical solutions to the problems we are facing relating to alcohol.

We are not out to ban alcohol – we just want to ensure that the public are aware of the risks associated with drinking, and to promote a sensible approach to it’s intake.

Dr Gibbons has expressed his concern that a person can consume more than their desired daily intake of alcohol for less than £1. Cheap alcohol and marketing has led to a society in which the entire population is drinking more than ever, posing serious risks to health of the nation.

It is time that the Government in Wales took control of this situation. The population is drinking in increasingly harmful ways and the result is a mixture of avoidable medical, psychological and social harm, damaged lives and early deaths.

Earlier in the year we published a report examining the damaging effect of alcohol marketing on young people. To read the report in full click here: "Under the influence - the damaging effect of alcohol marketing on young people" and tell me what you think.

A clearing in the fog?

The devolution settlement in Wales has often been referred to as a ”fog” , but today, the All Wales Convention has reported that the Assembly in Wales should be given full law making powers through a referendum, so there could be a clearing ahead.

The Convention, established by the Welsh Assembly Government, also said that a yes vote for further powers is attainable, that public support is out there, although it is not guaranteed.

For us, the transfer of full-law making power for Wales would be a welcome development on the current system.

BMA Wales gave evidence to the All Wales Convention earlier in the year, and I am pleased to see in the report that the evidence we submitted has been taken on board and cited on numerous pages.

We noted in our evidence that the current system by which the National Assembly can acquire legislative powers is cumbersome and thus not widely understood by the public in general - including BMA members.

In the context of a UK membership organisation, professional association and trade union that the BMA is, there is often central confusion about the extent to which the National Assembly for Wales can legislate in health matters. This can lead to Wales being left behind as it does not have the same tools available to implement BMA policy as is available to our counterparts in other nations. In contributing to debates on policy, in particular on a UK basis, it would be far more straightforward for members in Wales to be reassured that similar legislative change as is often proposed for Scotland and Northern Ireland could also be implemented in Wales by Welsh Ministers.

At the moment, the ability to develop and implement new policy via the legislation route is let down by the need to obtain ‘permission’ from Westminster, and the subsequent delay in that process. Using BMA Wales’ experience with the introduction of a ban on smoking in public places, we highlighted problems inherent within the present system. Although Wales were at the forefront in calling for a ban, ultimately the ban was only implemented marginally ahead of that in England, even though Wales had started the process much earlier. The delay in legislating in Wales caused by the lack of primary legislative powers can be argued to have led to many individuals health being damaged by exposure to environmental tobacco smoke in the interim period.

The report suggests that the Assembly should decide on whether to hold a referendum by June 2010, well in advance of the next Assembly elections. The timing of a referendum is clearly one for the politicians but the view of BMA Wales is that we support primary powers simply to allow effective, timely and consistent policy change in health (and the related portfolios) and to enable the Association work effectively with our members – on an equal footing as our colleagues across the UK.

I look forward to further developments – and to the statement by the First Minister next week.

WELCOMED: Proposals to Close Sunbed Regulation Loop-hole

Today the National Assembly’s Health Committee publishes its report looking into the use and [serious lack of] regulation of the sunbed industry in Wales.

A clear message to discourage the use of sunbeds was sent out earlier this year following the success of our campaign to get local authorities in Wales to remove the sunbeds they operated in their local leisure centres.

Now the Welsh Assembly has the opportunity to develop on that, to steal a march and introduce adequate measures to regulate the commercial tanning industry and thereby protect public health in Wales.

The Health Committees report makes for very interesting reading, and while I would pick the Committee up on a few, very small, points in the document (as you would expect, you might say), BMA Cymru are absolutely delighted with its conclusions.

The report shows that the Committee has listened to the evidence it received – not just from us and the wider healthcare profession - but from a whole host of organisations and even from parents.

In line with our recommendations the Committee is asking the Welsh Government to “seek the legislative competence to introduce new laws to enable local authorities in Wales to regulate, license and, if necessary, impose liabilities and create offences in relation to sunbed facilities and their operators.”

Again, in line with our recommendations, (link) the Committee says that these new laws should be based around recommendations 1 and 2 of the thirteenth COMARE report on ‘The health effects and risks arising from exposure to ultraviolet radiation from tanning devices”.

As a minimum, the law should ensure that:
• use by under 18s is prohibited;
• use by other high risk groups is discouraged;
• facilities provide full-time supervision by well-trained staff;
• use of protective eyewear is compulsory;
• information setting out the potential health risks of using sunbeds is prominently displayed and provided to all users;
• information containing unproven health benefits of sunbed use should be prohibited from premises;
• written informed consent is obtained from all clients prior to use; and that
• facilities should not be allowed to use sunbeds that do not comply with both the British and European Standards on sunbed irradiance levels.

We will be urging the Health Minister and the Assembly Government to adopt and bring forward these proposals as soon as possible.

For us the essential point is that there is no such thing as a safe tan (unless it comes out of a bottle). The damage to your skin remains long after a tan has faded.

There is one area of regulation of the sunbed industry which we would like to see Wales go further on – that is advertising.

Although the report suggests that investment in the SunSmart campaign is needed on a UK level - bill-boards, posters and leaflets advertising commercial outlets continue to line most high streets in Wales. Although I’m not aware of any detailed study to date, I think it’s fair to say that these tend to be targeted towards our more deprived communities – and towards young people.

In our view a move to place tighter regulation on the commercial sunbed industry - including inspection and licensing, a restriction for under 18s and a ban on unsupervised salons - would be significantly more robust and complete, if it included some level of control on advertising and marketing.

HIV Related Discrimination by Healthcare Professionals

I’ve just got back from the Assembly, where Dr Tony Calland and I gave evidence to the Equality of Opportunity Committee on discrimination against people living with HIV by healthcare professionals.

This by its very nature is a difficult issue.

But it’s compounded by the fact that there is no real evidence base in Wales from which to work from – at the moment the evidence of discrimination (by doctors and other health care professionals) is anecdotal.

And therein lays the problem. This lack of comprehensive evidence base is what the committee is working from; and as Jonathan Morgan AM points out they well struggle with this particular inquiry.

Advances in medicine and the ‘normalisation’ of how the HIV virus is treated have challenged much of the stigma previously found in healthcare settings.

That is not to say that discrimination is not occurring. I accept that unfortunately it may well be.

As we said in our paper, discrimination of people diagnosed with HIV by any healthcare professional is unacceptable, and is a breach of fundamental human rights – rights that are central to the practice of medicine.

Discrimination - whether actual or perceived - has a negative impact on health outcomes, and contributes to both a reduced use of prevention services and perhaps a higher rate of onward transmission. I suspect, however, that this point is obvious to most people.

Surprisingly perhaps, what’s less obvious to many people is what actually constitutes stigma and discrimination – and the effect that it can have.

Any drive to combat this should be directed at the whole healthcare team (managers, doctors, nurses, receptionists, social workers, clerks).

Non-HIV specialists may feel a lack of confidence in treating HIV patients – even if they present with common complaints. I would argue that for these clinicians, a tendency to refer HIV patients to specialist clinics or consultants arises from a lack of specialist knowledge and a desire to do right by the patient, to ensure they get the right care, rather than a reluctance to treat HIV patients on the basis of prejudice or discrimination.

This applies to many other conditions, such as diabetes and cancer, not just HIV.

It’s also important to remember that clinicians employ universal cross contamination measures for all patients (e.g. see 1000 lives campaign), because every patient could potentially have, for example, a blood borne virus or transmissible infection and are so far undiagnosed.

Precautionary measures which may seem to be over-the-top are often standard clinical practice.

A lack of knowledge about HIV, and misconceptions about onward transmission, fuels stigma and discrimination. As Dr Calland told the Committee this morning – ignorance may be the problem not prejudice.

I will follow the Committees inquiry with interest, and in the meantime we are planning to meet with the various organisations and representatives in Wales to see how we can improve on this agenda, jointly.