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.

Alcohol Abuse: An Integrated Approach Forward

Last week we brought together leading UK experts to speak at our seminar on alcohol abuse, and to debate an integrated approach forward in tackling Wales' growing drink problem.

Speakers included: myself; Dr Zul Mirza, President of the Emergency Medicine Section, Royal Society of Medicine; Simon O’Brien, Deputy Inspector of policing for Ireland; Professor Eileen Kaner, Chair, Alcohol Programme Development Group NICE; Wynford Ellis Owen, Chief Executive of The Welsh Council on Alcohol and other Drugs; Andy Tighe, Director, Brewing, Beer and the Pub Association.

You can watch the seminar here.

We know that Health Minister Edwina Hart would like to see action on alcohol pricing from her statement in Plenary last month, and we are urging the Minister to act sooner rather than later in seeking further powers to tackle alcohol abuse, to help improve the health of the people of Wales.

Recent years have seen an increase in the levels of alcohol misuse in Wales, and in particular the pattern of binge drinking and heavy drinking.

Alcohol consumption is associated with a wide range of medical conditions and is a significant cause of morbidity and premature death. It contributes to a range of acute and chronic health consequences, from alcohol poisoning and injuries resulting from traffic crashes to cancer and cardiovascular disease. The more an individual consumes, the greater the risk of harm.

Alcohol misuse is associated with crime, violence and anti-social behaviour, and can impact significantly on family and community life.

Below are our recommendations to tackle alcohol abuse which we intend to send to the Health Minister:

• Taxation on all alcoholic beverages should be increased at higher than inflation rates and this increase should be proportionate to the amount of alcohol in the product.

• Legislation should be introduced to:
-prohibit irresponsible promotional activities in licensed premises and by off-licenses
- set minimum price levels for the sale of alcoholic beverages

• It should be a legal requirement for alcohol labeling to include the following information:
- alcohol content in units
- recommended daily UK guidelines for alcohol consumption
- a warning message advising that exceeding these guidelines may cause the individual and others harm

• Licensing legislation should be strictly enforced, including the use of penalties for breach of license, suspension or removal of licenses, the use of test purchases to monitor underage sales, and restrictions on individuals with a history of alcohol-related crime or disorder. There should be adequate funding for enforcement agencies, with consideration given to the establishment of a dedicated alcohol licensing and inspection service.

• A statutory code of practice on the marketing of alcoholic beverages should be introduced and rigorously enforced. This should include a ban on:
-marketing of alcoholic soft drinks to young people
-alcohol industry sponsorship of sporting, music and other entertainment events aimed mainly at young people
-broadcasting of alcohol advertising at any time that is likely to be viewed by young people

• The legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100ml throughout the UK.

• Public and school-based alcohol educational programmes should only be used as part of a wider alcohol-related harm reduction strategy to support policies that have been shown to be effective at altering drinking behaviour, to raise awareness of the adverse effects of alcohol misuse, and to promote public support for comprehensive alcohol control measures.

• The detection and management of alcohol misuse should be an adequately funded and resourced component of primary and secondary care to include:
- formal screening for alcohol misuse
- referral for brief interventions and specialist alcohol treatment services as appropriate
- follow-up care and assessment at regular intervals

Alcohol Pricing

This afternoon in Plenary Health Minister Edwina Hart AM set out the Welsh Assembly Government’s position on alcohol pricing.

I’m pleased that the Welsh Assembly Government are taking the issue of alcohol abuse seriously.

In recent years, the affordability of alcohol in the UK has been increasing, and this has played a significant role in the rise in alcohol consumption.

There is strong and consistent evidence that alcohol consumption and rates of alcohol-related problems are responsive to price.

It is clear that the relationship between the affordability of alcohol and the level of consumption provides an effective tool for controlling levels of consumption and reducing levels of alcohol related harm.

We believe it is essential that there is an increase in the level of excise paid on alcohol in the UK, and this should be relative to the number of units of alcohol. This increased taxation would not only reduce alcohol consumption and its related harms, but would also contribute to providing the necessary funding to meet the social and economic costs of these harms like police enforcement measures, healthcare service costs and treatment services.

We at BMA Cymru urge the Minister to act sooner rather than later in seeking further powers to tackle alcohol abuse, to help improve the health of the people of Wales.

Changes to NHS Wales

Edwina Hart is certainly a Minister willing to shake-up our NHS.

She's signed the death certificate for the much maligned internal market in NHS Wales – effectively ending the purchaser/provider split.

For our part, BMA Cymru Wales’ has consistently called for an end to the internal market which only serves to undermine the public service ethos and erodes the relationship between professional colleagues, wasting money on bureaucracy that can be put to better use on front line patient services.

Such a move should allow us to take a fresh look at managerial culture, which has distorted clinical priorities to the disadvantage of patients.

The Minister has announced the end of NHS Trusts and LHBs in their current form. These bodies will be reconstituted as one unified body, effectively creating a single local health organisation, responsible for delivering all healthcare services within a geographical area.

In principle, BMA Cymru Wales supports any plan to reduce the number of structures that detract from and absorb resources from the provision of front-line NHS services.

But if the Minister thinks that this is the end of the debate, then some time to pause and think again, would be advised, as there still appears to be some life in the structures argument yet.

For all the political rhetoric – the real work is yet to be done. Far from a done deal many have argued that rather than ending the internal market, NHS Wales could be sleep-walking from the existing internal market between commissioners and providers to a new competitive environment between primary and secondary care, as scarce resources are fought over.

This is causing concern amongst some parts of the medical profession – especially GPs. Understandably, they fear that any new unified bodies, particularly if the intention is to base them at Hospitals trusts, will simply see them continuing to focus on the acute/hospital-based activity. Unsurprisingly, most GPs remain in favour of a model which incorporates a distinct ‘community services’ provider as a counterbalance to the hospital focus that a unified Trust maybe persuaded to take.

GPs fear that the removal of a boundary between primary and secondary care equates to primary and community care being subsumed into a large unified body that will fail to give primary care adequate priority. Worse of all, rather than reverse the flow of resources from primary to secondary care, an Integrated Trust could actually accelerate and exacerbate existing problems.

BMA Cymru Wales will expect from the Minister significantly greater clarity and more detail for the next stage of the consultation process. In our initial response, we made it clear that any ‘integrated’ health body could only be supported if two essential criteria were met.

Firstly, that the new body must be designed as an entirely new entity – rather than one built purely around the NHS Trust model with its present focus on acute/secondary services; and secondly that it works in partnership with GPs, but not interfering with their independent contractor status, which allows them to exercise their patient advocacy role, so valued by patients.

The Minister’s commitment to take the time to do things right is to be welcomed but a ‘can-do’ Minister, perhaps with one eye on the top job – time may not be something that this Minister is willing to waste.