Seasons Greetings

I would like to wish all our members and regular observers of my blog a very merry Christmas and a happy new year.

2010 will inevitably bring with it huge challenges to the NHS in Wales, particularly in the light of financial uncertainty and real cuts in funding of public services. However, whatever the New Year brings you can rest assured that BMA Cymru will continue to be at the forefront of discussions, striving to improve the health of the people of Wales by representing the doctors who care for them. We believe doctors in Wales can provide the medical leadership needed to ensure NHS Wales delivers the services that will improve outcomes for our patients. While service delivery is important, so too is the training of the doctors of the future; one cannot be sacrificed for the other if we are truly to create sustainable excellence in healthcare attracting and retaining the very best doctors to Wales.

BMA Cymru looks forward to working hard on behalf of its members in 2010, and sends Seasons Greetings to all - especially those working for our patients over the holiday period.

Presumed consent: the debate

Fervent debate has followed the announcement by Health Minister Edwina Hart last Friday that Wales could move to a system of presumed consent for organ donation.

Jonathan Morgan AM has voiced his concern over the announcement. This is what I said in response:

“We recognise that the introduction of an opt-out system would be a controversial decision, and as such those who do not want to donate their organs will sign up to opt out. A law on presumed consent would, at a single stroke, save lives whilst still giving the individual the right to have a choice.

“Given the very high level of support for organ donation expressed in repeated surveys it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not.
“Presuming consent rather than presuming objection is more likely to achieve the aim of respecting the wishes of the deceased person.

“We believe that with further debate and information about the way such a system would operate, there will be widespread public and professional support for such a change.

“The gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

“We must recognise that the current system is unable to meet the increasing demands placed upon it. Steps must be taken to increase the availability of organs for transplantation.

“Let’s show that we still care deeply about the health of our nation and that we are willing to lead with bold initiatives whilst other countries dither and waver.”

I’m looking forward to hearing Jonathan’s response.

We will continue our work with the Welsh Assembly Government and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option. You can expect to hear a lot more from us on this important issue.

What are your views on the announcement?

Organ Donation in Wales

BMA Cymru Wales is delighted with the announcement that the WAG will explore the possibility of introducing a soft opt out system for organ donation in Wales, and that a bid for a Legislative Competence Order will be submitted.

I hope that this brave decision by the Health Minister will mark a small step towards ending the tragedy of patients dying while waiting for a transplant.

Organ transplantation saves lives and it can transform the lives of people suffering disability and the tremendous burden of dialysis. There have been many high profile cases highlighted by the media over the last few years which touched us all.

As long ago as 2000, doctors voted for an opt-out/presumed consent scheme to be introduced in the UK following its success on the continent which increased the number of organs available for transplants and therefore reduced the number of patients who die waiting for a transplant. They also agreed that a public education campaign about the merits of organ donation should take place before introducing the scheme.

BMA Cymru Wales will continue to work with the Welsh Assembly Government, Kidney Wales, and other partners over the next few months to raise public awareness of the urgent need for change and the rationale behind the presumed consent option.

Tell us what you think of the announcement.

Responsible drinking

As pubs and clubs are gearing up for one of the busiest nights of the year - widely known as “Black Friday”, BMA Cymru are urging party goers to drink responsibly tonight.

Black Friday has become one of the busiest nights of the year for those working in Hospitals and the emergency services in Wales. Hospitals are busy putting extensive contingency plans in place to cope with an influx of alcohol induced injuries.

The combination of the Friday before Christmas, pay-day and binge drinking will put an increased strain on services in Wales.

Anti-social behaviour, violence, and drink-driving will multiply this weekend across Wales due to an increased level of alcohol intake, and in many cases, binge drinking.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. I've said it before - we are not looking to restrict people from having a choice about consuming alcohol, we just want to encourage adults to drink in moderation, rather than drinking to get drunk.

Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking.

It is vital that people make alternative arrangements for getting home if they are drinking this weekend. Even driving the morning after can be dangerous as alcohol may still be in the system.

I met with Kate Edwards and Melanie Hamer of Pontypridd Women’s Aid recently who have considerable experience in supporting and dealing with victims of domestic violence. They were extremely concerned that the number of complaints about domestic violence would increase this weekend. Kate Edwards who is the Chair of Pontypridd Women’s Aid said:

“There will be a visible police presence out on the streets prompting some to take their anger out at home.

“It is particularly sad when such incidents occur at a time which is meant to be a happy one. Domestic violence can have a dreadful effect not just on the victim, but of course on the children and it can end up not just ruining their Christmas, but impacting adversely on the rest of their lives.”

So the message from us at BMA Cymru is – enjoy a drink, but don’t overdo it.

BMA Cymru support Julie Morgan MP's private members bill

Julie Morgan, MP for Cardiff North has put down a private members bill which would ban under 18’s from using sunbeds, and ensure all sunbed use in England and Wales would be supervised.

BMA Cymru are delighted that Julie has chosen to use her bill to close a loophole in law to protect the public – particularly young people – from the dangers of sunbeds and from over-exposure to intense UV radiation.

This is something we have campaigned heavily on this year in Wales - calling for tighter regulation of the commercial sunbed industry; particularly for a ban on coin-operated / unsupervised salons and a ban on the use by under 18s.

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” - the highest risk category.

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.

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 are no formal guidelines about standards of private sector tanning salons, the ones which do exist are only advisory and providers are free to ignore them. Anyone can decide to set up a tanning salon, and they need no training or qualifications.

In 2009, there is no excuse for such lax regulation. When we gave evidence to the National Assembly for Wale’s Health Committee inquiry a few months ago that is exactly what we said – we are delighted that the Committee took our recommendations forward, and now we are even more delighted that Julie Morgan MPs Private Members Bill could close this gap in public protection on a UK level for good. We will do everything we can to support her.

The bill has it’s second reading on 29 January 2010 – we will be watching closely.

Tell us what you think of this private members bill.

Our booze culture

The Western Mail has reported today that the number of people admitted to hospital with alcohol-related conditions has risen by 30% in five years.

These figures are unsettling. The population is drinking more and our society is awash with pro-alcohol messaging, marketing and behaviour.

Over the festive period, the admissions to A&E for alcohol misuse will put a huge strain on NHS resources. Intoxicated patients are dealt with by a variety of medical staff and even security guards if they are violent and abusive. Added to this are the costs of tests and treatment, and if the patient is then sent to a hospital bed on a ward, the costs mount up even further.

Supermarkets offering cut price deals and drinks promotions in pubs and clubs exacerbate the problem as people indulge over this period. All these promotional activities serve to normalise alcohol as an essential part of every day life. It is no surprise that young people are drawn to alcohol - when it is cheaper than bottled water, we have to worry about what message we are sending our children.

Alcohol misuse causes family breakdowns, is a major factor in domestic violence, is often related to crime and disorderly behaviour and it kills. It is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The public should be made aware of the serious risks associated with drinking, so that they can make informed decisions about how much alcohol they are consuming.

Alcohol can be an enjoyable part of social and cultural life especially over Christmas. But the growing booze culture is creating serious problems for the future. Sometimes people may not even be aware that they are drinking too much – it is easy to do. It is important to keep track of how much you are drinking. We would like to see people enjoying alcohol sensibly without over doing it.

Are you a healthcare professional who has dealt with patients who have been admitted due to alcohol misuse? Share your experiences with us.

Action on aggressive behaviour in A&E

I am pleased that the pilot to install CCTV in 4 A&E departments in Wales is being rolled out today and if successful, will be extended across Wales.

The Minister is clearly taking action on the violence and aggressive behaviour agenda.

BMA Cymru have repeatedly stated that there should be zero tolerance to violence of any sort in the NHS and the mechanisms must be there to minimise the likelihood of attacks, to support staff who experience them, and to ensure that anyone who commits an act of violence is dealt with appropriately.

Hopefully these cameras will make people think twice before attacking hospital staff who are trying to ensure the good health and well-being of patients.

Progress still needs to be made however, on protecting those working in primary and community care – especially the lone workers who are particularly vulnerable. I blogged earlier in the year on what BMA Cymru believe would be the most effective mechanisms to eradicate the problem.

I hope that this pilot will prove successful and demonstrate that violence against healthcare workers will not be tolerated.

Have you been subjected to violence and aggression in the workplace? Tell us about your experiences.

Room for improvement

Auditor General Jeremy Colman, has today published a report entitled "Unscheduled care: developing a whole systems approach", which concludes that despite the strengths of the current system, there is work needed to improve the way which services work together.

The BMA has been calling for better service integration within the Welsh NHS for a long time - unscheduled care plays a key part in that agenda.

The report says that too many people who have urgent reasons to access the NHS or social services are encountering inefficiency, uncertainty and delays. Jeremy Colman says that a solution to this would be to show people how their needs can be met more effectively elsewhere.

It may sound obvious, but ensuring that patients are seen or treated in the right place at the right time will make a big difference to the efficiency of NHS services and so it is essential that we get that right.

The report recommends that the new LHB’s should take the lead in redesigning the structure of unscheduled care. I hope the Minister considers this and will take the appropriate action to address the issue. Of course, any changes must be backed by an effective channel of communication and better working practices.

In addition, universal targets for seeing patients in A & E Departments are skewing priorities – patients in more need should be prioritized and treated accordingly. That is just not happening at the moment. The use of smarter targets is a real solution to that and something we have been encouraging the Assembly Government to look into.

We must be careful not to undermine what we already have in Wales both in general practice and in secondary care. We need services that support and compliment each other – the danger which has become apparent is that unscheduled care has become a separate and isolated part of an already disjointed service.

At a time where NHS reorganisation is taking shape, it is crucial that the Minister acts now, so that the future benefits of the NHS in Wales can be fully realised. We would very much welcome the opportunity to work with the Assembly Government and the new LHBs on improving the service.

If you have any thoughts on the report, let me know.

Chief Medical Officer for Wales publishes Annual Report

Wales’ Chief Medical Officer Dr Tony Jewell, has today published his annual report which looks at different methods of prevention to ensure the long-term health of the nation, including immunisation, screening and education.

He warns that preventing disease and illness is the key to a healthy future generation. I welcome this report and agree with the recommendations Dr Jewell sets out for improving the health of the nation. It is vital to focus on health promotion and illness prevention as well as illness itself.

Dr Jewell says that overall health in Wales is continuing to improve, but continued action is still needed to address issues like obesity, binge-drinking and smoking. These three issues are important for BMA Cymru members, and for years we have been trying to improve the health of the nation by campaigning for smoking bans, minimum pricing for alcohol and preventing childhood obesity.

The effect of the smoking ban is noted by Dr Jewell in the report. Findings from research commissioned by the Welsh Assembly Government show clear evidence of reduced exposure to environmental tobacco smoke, particularly in pubs, clubs, bars and at work. This means that the legislation has achieved its main objective to reduce environmental tobacco smoke. It is encouraging that the studies found no evidence of any shift of smoking to the home, or of increased exposure to children.

BMA Cymru would like to see further action taken by the Government in the long run, including banning advertising and displaying cigarettes at point of sale; as well as banning cigarette vending machines and scrapping the sale of ten packs.

Childhood obesity is a growing epidemic, and the soaring rates have lead to an increase in childhood type II diabetes and will lead to more future cases of heart disease, osteoarthritis and some cancers. Teaching children at an early age about the advantages of a healthy lifestyle and introducing exercise into a daily routine may prevent them from chronic health conditions later on in life.

A sensible approach to alcohol is always important, but it is particularly pertinent at this time of the year. We want the public to be aware of the risks associated with drinking, and would like to see advertising for alcohol banned as well as minimum price levels for the sale of alcohol.

Health Minister Edwina Hart has welcomed the report and the recommendation that more focus should be placed on preventative measures. I look forward to seeing what action the Welsh Assembly Government takes. Let me know what you make of the report.

You say goodbye and I say hello…..

Rhodri Morgan will formally step down as First Minister of Wales today, and I would like to wish him well for the future.

After 10 years as the Leader of Wales, Rhodri leaves a great legacy behind him. Under his leadership we have seen devolution take shape and flourish, and his commitment to Wales is admirable. Over the last 10 years Wales has remained loyal to the true values at the heart of the NHS. We have gained free prescriptions and free hospital parking, and maintained a clear rejection to the introduction of competition, choice and greater use of the private sector.

The approach to healthcare in Wales has been compared to England by Morgan, as “clear red water”. This rejection of the internal market has become part of Welsh identity. Instead of targets and choice, we invest in community and preventative measures, and in promoting public health.

During the rest of this Assembly I look forward to BMA Cymru working with Wales’ new leader Carwyn Jones, to ensure that Wales is the premier place for doctors to come and train and work.

The recruitment and retention of junior doctors must be high on the Government agenda moving forward. If we don’t have the quality and quantity of doctors, the health service will fail to function. This is a great concern to us and our members.

I hope that he and the Health Minister will work with us to build a health system that delivers better health for the people of Wales. We realise that we are in the middle of a recession, and difficult decisions will have to be made, but it is vital that health is properly funded.

So fare-well Rhodri, and welcome Carwyn, we look forward to working with you.