BMA Cymru backs new GMC guidance on end of life care

New guidance for doctors, “Treatment and care towards the end of life: good practice in decision making” has been published by the GMC.

The BMA has been involved with the development of this guidance and we support it. How best to care for individuals at the end of life is one of the most complex areas in medicine and it is essential that clear guidance is in place to assist doctors to act in the best interests of their patients.

The emphasis on advance care planning discussions with patients is to be welcomed, taking onboard their wishes and preferences and subsequently delivering quality care partnered with these choices.

The guidance highlights the importance of good communication, and is clear about the need to work with the patient or where appropriate their relatives or advocate to ensure that they are treated fairly, with dignity and without prejudice.

It will also be invaluable for patients and their relatives who need the reassurance of readily accessible information about what to expect in the very anxious period at the end of a person's life.

The guidance and supporting materials are available on the GMC website here.

All Wales telephone advice, information and support service on alcohol and drug abuse

The Primary Care Support Service has launched a range of services for those with alcohol or substance use concerns. This includes on-line screening tools as well as a confidential telephone information, advice support service.

View the services online here

This new Pilot project has been developed in response to primary care professionals’ concerns about their alcohol and substance use. It will run until March 31st 2011 and is subject to on-going evaluation. A Motivational Interviewing approach is used.

Drinking and Cooking related fires a burning issue for the fire and rescue service

This week the North Wales Fire and Rescue Service are guest blogging as part of our ongoing campaign to tackle alcohol abuse. This article by Richard Fairhead, Senior Fire Safety Manager highlights another dimension to the discussion.

North Wales Fire and Rescue Service has recently launched another campaign focussing on drinking and cooking, this time to coincide with the World Cup football tournament.

This initiative is the latest effort in the region to discourage residents from attempting to cook after drinking alcohol.

Statistics across the U.K. show that one in every three fire deaths is drink related, and the majority of accidental domestic fires begin in the kitchen.

In 2007, Sean Bowers, 24, from Penyffordd and Andrew Roberts, 39, from Ruthin, both died following separate fires in their homes both caused by chip pans. Both had been drinking, and had arrived home to cook themselves something to eat. Andrew had finished cooking and had fallen asleep on the couch but failed to turn off the gas. Sean also fell asleep with the chip pan left on the stove. The chip pans overheated and caught fire - Sean and Andrew never woke up.

Leaving cooking unattended is often a recipe for disaster and if you've been drinking you're even more vulnerable as you're at high risk of being distracted of falling asleep. Drink affects people mentally and physically, increasing their likelihood of having a fire and slowing their reaction times when one breaks out.

If you're asleep and a fire breaks out, you're in serious trouble. Just a couple of breaths of fire smoke can be enough to knock you completely unconscious. The smell of smoke doesn't wake up you up - the poisonous gases produced by a fire numb the senses and put you into a deeper sleep. This is why it is essential to have working smoke alarms in your home. Frighteningly, you are also putting the lives of your whole family at risk - a child can die from smoke inhalation in under a minute.

Despite the old proverb 'a watched pot never boils', keeping a close eye on your cooking really will save your life. Whether you've had a few drinks or not, our advice to cooks is quite simply to stand by your pan and get working smoke alarms.

Avoid your lives going up in smoke by following the tips listed below.

- Never cook after drinking - prepare a sandwich or get a takeaway instead.
- Don't leave cooking unattended -a small fire can quickly turn into a life threatening one. A household fire doubles in size every thirty seconds.
- Ensure you have a working smoke alarm in your home, and test them once a week.
- Formulate a fire escape plan to ensure that you and your family know how to escape safely in the event of a fire.

All three fire and rescue services in Wales fit alarms free of charge, and will give fire safety hints and tips as well as helping you design a fire escape plan for your home.

To take advantage of their friendly and informal home visits, residents can book a free Home Safety Check by calling the 24 hour hotline on 0800 1691234 or texting 88365, ensuring they prefix the message with the word HFSC.

Letter from the Minister - Vaccination uptake in 2009-10

I have received a letter from the Health Minister Edwina Hart regarding vaccination uptake in 09-10.

The Minister asks for her message of personal thanks to be shared with everyone involved in delivering vaccination services, and I would like to share her comments on this blog.

The letter reads:

I was very pleased to see the Public Health Wales annual report on the routine childhood vaccination programme. I noted particularly that, national uptake of all vaccinations by one year old is at the 95% target. Also that uptake of both MMR doses continues to increase towards target. This is all very good news.

There is still some way to go to reach target in the pneumococcal and Hib/MenC levels and uptake in the teenage booster is worryingly low. I am expecting to see improvements in these programmes during this year.

Vaccination is the best way of protecting children – and the wider community – against potentially very serious illnesses. We will achieve high uptake levels in all childhood programmes only through the efforts of local health professionals who support parents in making informed decisions about vaccination. I therefore want to thank everyone involved for their hard work last year when considerable challenges were faced during the swine flu pandemic.

I would appreciate this message of personal thanks being shared with everyone involved in delivering vaccination services.

BMA Cymru welcomes call to lower drink-drive limit

BMA Cymru Wales is very pleased that the North Review is calling for a reduction in the drink drive limit and we urge the UK government to act on the review’s findings.

We have lobbied for a reduction in the drink drive limit for over twenty years, and contributed to the North Review. We believe that such a move will help prevent deaths and reduce the number of lives ruined by drink-driving.

Scientific evidence from around the world has agreed that once a person’s alcohol level goes over 50mg their driving becomes impaired.

A reduction in the limit would also bring the UK in line with most other European countries, and would be in agreement with the best available evidence on the effects of alcohol on driving.

The introduction of the current limit, backed up by police enforcement and TV and media education campaigns, led to a dramatic fall in the number of deaths on the road, but the position has been stagnant since 1993. We need a new impetus to reduce the toll of injury and death.

The BMA is not suggesting a zero limit because there will be cases where an individual would register slightly above zero, even when they had not been drinking (diabetes and the use of mouthwash can both cause an above-zero level). The BMA doubts whether an absolute zero would be enforceable and acceptable to the public but argues that a 50mg level, would be effective and beneficial.

Scientific evidence from around the world has agreed that once a person’s alcohol level goes over 50mg their driving becomes impaired.

We would also like to see roadside random breath tests carried out. This measure is a vital element in deterring people from drinking and driving.

As a road accident doctor and a member of the British Association of Immediate Care (BASICS), I go to road accidents to provide advanced medical care with the emergency services, and I have seen at first hand the awful and devastating consequences of drink driving.

Why Wales has to attract the best medical talent

Our Public Affairs Officer Carla Mahoney has written a column for the Western Mail today. It looks at the inadequate staffing levels in the NHS in Wales.

Take a look here and leave a comment on this blog if you have something to share on this topic.

Diabetes Week 2010

This week is Diabetes week, an annual nationwide awareness week organised by Diabetes UK with the aim of raising awareness about diabetes and the issues people living with the condition face.

Diabetes Cymru UK are raising awareness this week about the key myths about diabetes, and have asked me to share some key facts and statistics with readers of this blog.

Diabetes costs the NHS in Wales £500m a year and is increasing rapidly.

According to the latest QOF statistics, released in September 2009, more than 146,000people in Wales – almost one in 20 people – have been diagnosed with diabetes. This figure had risen by more than 7,000 compared to the previous year’s statistics. The Welsh Assembly Government estimates that a further 50,000 people in Wales have undiagnosed diabetes.

Around 90 per cent of people diagnosed with diabetes have Type 2 diabetes. Usually diagnosed over the age of 40, the condition happens when the body stops making enough insulin or when it cannot use the insulin it produces. Eighty per cent of cases of the condition are associated with being overweight, but other risk factors for the condition are having a large waist and having a close family history of the condition. Being from a black or South Asian background makes people more likely to develop the condition and people from these communities are at risk of the condition from the age of 25. Type 2 diabetes can be treated with diet and exercise, tablets or insulin injections (30 per cent of people with the condition are treated with insulin injections). Many people with Type 2 diabetes assume that it is not as serious as Type 1. In fact, both conditions are serious.

Around 10 per cent of people diagnosed with diabetes have Type 1 diabetes. This condition happens when the body stops producing any insulin and is usually diagnosed in childhood and under the age of 40. It is not associated with lifestyle and cannot be prevented. Type 1 diabetes is always treated with insulin injections or an insulin pump, a device which constantly infuses fast-acting insulin into the body.

The complications of diabetes are heart disease, strokes, kidney disease, visual problems that can lead to blindness, and amputation. People with diabetes can reduce their risk of developing these complications by eating a healthy, balanced diet, maintaining a healthy weight, keeping active, taking their prescribed medications and keeping their blood glucose levels within the recommended levels.

People can live with diabetes for up to 10 years before it is diagnosed, which means half of these people already have developed the complications of diabetes. Many people can miss the symptoms of diabetes as they can often be mistaken for getting older and being stressed. The key symptoms of diabetes are going to the toilet more often to pass water (particularly at night), extreme tiredness, blurred vision, genital itching, regular episodes of thrush and slow-healing wounds.

People from deprived communities are up to twice as likely to develop diabetes. In Wales, there is a big variation of the percentage of the population diagnosed with the condition in different areas. According to the latest QOF statistics, Blaenau Gwent has the highest percentage of the population diagnosed with diabetes at 5.8 per cent. This is significantly higher than the area with the lowest percentage, Cardiff, which has 3.6 per cent of the population diagnosed with diabetes.

Diabetes UK Cymru provides advice, support and information for people with diabetes and their families and funds research into diabetes. The charity also does a series of talks for GPs every year and organises an annual conference for healthcare professionals in Wales.

For more information, contact 029 2066 8276, email wales@diabetes.org.uk or visit www.diabetes.org.uk/wales. The charity can also be found on Facebook and Twitter at http://twitter.com/DiabetesUKCymru.

I wish them the best of luck with raising awareness this week!

Time to tackle the affordability of alcohol

NICE have today published guidelines to tackle alcohol misuse.

BMA Cymru have been saying for some time that tough action is needed to tackle this issue. We are pleased that NICE is joining our call for a ban on alcohol advertising and the introduction of a minimum price per unit of alcohol.

Critics of minimum pricing should read the research by Dr Robin Purshouse on alcohol pricing - it makes for interesting reading. He estimates that a minimum price on every unit of 40 pence would result in about 1,000 fewer premature deaths a year, around 40,000 fewer hospital admissions a year, and about 10,000 fewer violent crimes and criminal damage incidents per year. Read his report here.

We are convinced that in order to tackle alcohol misuse a whole raft of measures is required, which include reducing availability, increasing taxes on drinks with the highest alcohol concentration, reducing the drink-driving limit and tackling advertising and minimum pricing.

We are not opposed to people drinking alcohol in moderation - what we want is to help people avoid using alcohol at levels which endanger their lives and those of others.

A few weeks ago we held a seminar on tackling alcohol abuse: an integrated approach forward. Watch it here.

What do you think about the recommendations from NICE?

Why Wales has to persuade doctors to come home

I was pleased to read this article in the Western Mail yesterday written by Conservative Assembly Member Andrew RT Davies, endorsing our We'll Keep A Welcome campaign.

BMA Cymru have consistently highlighted the problem of the shortage of doctors in Wales, which could lead to the NHS becoming unsafe for both staff and patients.

This campaign is the latest move by BMA Cymru to promote Wales as a desirable place to live and work.

We have contacted all schools in Wales to reach out to prospective medical students before they leave for university.

All students have been sent packs which include letters from me, as well as from Welsh postgraduate dean Derek Gallen, along with information about training in Wales and posters to put up in medical schools.

Whilst we are happy to initiate grass roots action here in Wales, the Government has a responsibility to ensure that safety standards in Wales are maintained, and that the citizens of Wales receive the quality healthcare they deserve.

Follow our campaign by joining our facebook group here to keep up-to-date with the latest developments.

Tell us why you think Wales is a great place to live and work.....