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.

Welsh Cancer Standards

The Western Mail today reports on Wales falling short on meeting national cancer standards.

Health professionals throughout Wales are committed to providing the best possible services to patients, and welcome the Welsh Assembly Governments ambition to achieve 100 per cent compliance across this set of standards - unfortunately the reality falls woefully short of the ambition as this report highlights.

While acknowledging that much work has been done, this report highlights how much more there is to do.

Additional resources will be required to meet these standards - and even in these tight financial times, cancer services will remain a priority to doctors and patients in Wales.

The report highlights a shortage of specialists throughout multidisciplinary clinical teams. BMA Cymru have warned the Welsh Assembly Government repeatedly over the shortage of doctors in Wales, and this data adds wait to our argument.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas.

This is compromising consultants’ ability to deliver routine daily work, and there is no evidence that hospitals are adjusting services to take these shortfalls into account.

While BMA Cymru has been working with WAG and employing Local Health Boards around doctor shortages - many of our suggestions on how to address the current crisis we are facing have yet to be taken up.

Without doubt, the rates of work being undertaken cannot be sustained with the current levels of staffing.

The Welsh Assembly Government must ensure that training programmes are in place to provide future specialists.

Although the waiting times for radiotherapy have not improved, it is pleasing that the WAG identified the need for more resources in this area to ensure improvements were made. The recent investment into extended working hours and a national procurement programme for linear accelerators is to be welcomed.

The WAG must now ensure that sufficient resources are available in other areas to enable workers to implement recommendations.

Doctors are eager to drive forward efforts to improve the care cancer patients receive and are usually at the forefront of leading improvements and new initiatives; but sustainable solutions are needed to address the problems raised in this report if NHS Wales is to deliver and maintain the quality and capacity of cancer services that the people of Wales deserve.

1,000 Lives Campaign

This week, the 1,000 Lives Campaign which was designed to improve patient saftey in the NHS in Wales comes to an end. Here is an article which I wrote for the Western Mail about the campaign.

Patient safety is the highest priority for anyone working on the frontline in NHS Wales and it’s making a real difference in primary care.

That’s why the British Medical Association strongly supports the 1000 Lives Campaign and works hard to highlight those areas of patient safety and care that are important to our members.

For doctors, safety and quality go hand in hand, and the Campaign has created a focus around which those can be considered every day, in every patient contact, by health professionals and managers alike.

As we come to the final months of this two year campaign, we are pleased to see how much progress has been made across Wales.

When the initiative was launched in April 2008, it was the first time that primary care had been included in a similar patient safety campaign anywhere in the world.

Wales has led the way and our members have contributed in many of the Campaign’s areas, including improving leadership, medicines management and general medical care.

We have seen the impact made by establishing patient safety WalkRounds and culture surveys which have empowered our members to talk about their concerns and hopes for improvement.

Again Wales has led the way in this area, becoming the first country to arrange a safety culture survey for its general medical primary care services at a national level.

And the response from our members have been extremely positive with over 60 per cent of GP practices taking part.

The results have been helpful in identifying aspects of care working well, but also raised areas where there is scope for improvement.

BMA Cymru supports a healthcare service that listens to the concerns of doctors, acts on those concerns to improve safety and quality of care, and in which health professionals are not afraid to speak out.

Last year we published the ‘Speaking up for Patients’ report based on survey responses from 565 doctors working in England and Wales.

Almost three quarters (74%) said they had concerns about issues relating to patient safety over the course of their career.

Within in this group, 73% said their concerns related to standards of care.

Seven in ten doctors said they had raised their concerns but were not always satisfied with the response.

Often they were not asked for further information or made aware if any action was taken to improve the issue.

WalkRounds and culture surveys have the potential to examine and improve patient safety issues across the whole patient pathway.

Other areas that have helped to improve patient care are in medicines management and work to improve the quality of life for chronic heart failure patients.

More than 80 GP practices are working with Health Boards to reduce, where possible, the number of unnecessary hospital admissions for patients with chronic heart failure.

The promotion of evidence-based procedures such as timely and accurate diagnosis, medication therapy, and lifestyle advice could make a significant impact on the disease process.

GPs are also currently carrying out detailed work to improve the reliability of instructions given to patients about their medication.

We have already seen the difference this has made for patients who take Warfarin and we are looking at other areas including diabetes.

The development of the primary care trigger tool to measure improvements is also being embraced by members.

We know that all our GP practices are continually making changes to ensure the care they deliver to their patients is the best possible.

But now, thanks to the trigger tool they will be able to actually measure those improvements, see how they are working and if they are making a difference.

One of the fundamental features of the new tool is looking at harm caused by failure to recognise or adequately manage a new presentation of an acute illness.

If a patient’s problem does not respond to treatment or they develop an adverse reaction, they are likely to make another appointment.

It is these unscheduled reattendances that can act as triggers of possible harm.

We are proud to see the progress made through the 1000 Lives Campaign, and that doctors across Wales are playing their full part in it.

BMA Cymru will continue to support the Campaign and to highlight those areas of healthcare over which our members have concerns – so that patients can look forward to even safer services in Wales.

What are your views on the 1,000 Lives Campaign?

“I am proud to work in the Welsh NHS” – Dai Lloyd AM

Croeso i Gymru! – Welcome to Wales! In Europe’s oldest living language, Welsh reflects the unique cultural and historical experience that is Wales. And, as a practising GP and a Member of The National Assembly for Wales, I am very well aware, naturally, that the National Health Service also, looms large in the National conscience of Wales.

From the history of the mining communities of the South Wales Valleys leading to the formation of the Tredegar medical Aid Society as a forerunner and template for the later NHS, the Welsh experience is not confined to the usual cultural issues, but extends to the Health Service too.

With the establishment of the NAFW in 1999, Health was devolved to Wales. Health Policy has developed differently here, and I am proud to work in the Welsh NHS.

Here in Wales, prescription charges were abolished in 2007. Patient care is thus not compromised by the cost of prescription items, people no longer have to choose themselves which item(s) in a multiple prescription to ditch. Northern Ireland and Scotland are following this proud example.

The internal market in Health has been dismantled with the latest NHS reorganisation in October 2009, Seven Health Boards now plan services – commissioning is a thing of the past.

In addition, no new PFI ventures are being undertaken in Wales, and the NHS in Wales remains a publicly-funded public service, with little private medicine. That is a reflection of the tremendous loyalty and trust that people still have for the NHS in Wales, a loyalty that is reflected in the esteem and respect accorded to the Nation’s Doctors and NHS Staff in general.

GPs here are not faced with the ubiquitous ‘Choose and Book” system and waiting lists have improved out of all recognition in recent years. Devolution brought more Medical Schools in Swansea and North Wales, and an exciting new, Postgraduate Medical School in Swansea.

The accent is rightly on Public Health in Wales, and history will record the first vote to ban smoking in enclosed public buildings in these Islands occurred in the National Assembly for Wales in January 2003. The absence of the relevant powers however, meant the ban had to wait until April 2007 to kick in.

For doctors certainly, Wales offers a different experience – yes, the fine scenery of mountains, beaches and breathtaking views – yes, the history and traditions – and yes, also an NHS still true to its founding principles.

Croeso i Gymru!
Dr Dai Lloyd AM South Wales West
Plaid Cymru

400 doctors short in Wales

The BBC have reported today that Wales is short of almost 400 doctors.

These problems come as no surprise to us at the BMA, having predicted that these shortages would happen at some point.

For some time now we have been trying to meet with representatives from the WAG, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation.

The levels of a lack of middle grade and junior doctors right across Wales is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future. The Health Minister should treat this situation with urgency.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas.

This is compromising consultants’ ability to deliver routine daily work, and there is no evidence that hospitals are adjusting services to take these shortfalls into account.

Without doubt, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers must address this now, working with clinical colleagues.

The idea for our latest campaign "We'll Keep a Welcome", which aims to attract Welsh students who have left the country to study medicine to return to Wales to train as doctors, came about in an effort to tackle the problem of the severe shortage of doctors in Wales.

The safety of both NHS staff and patients is key, and we will need sustainable solutions for the future if NHS Wales is to deliver and maintain the quality and capacity of services that the people of Wales deserve.

Action after inquiry needed on stroke services in Wales

BMA representatives have given evidence this morning to the Assembly’s Health, Wellbeing and Local Government Committee inquiry into Stroke Services in Wales. Several other groups with an interest in this area have also given evidence, along similar lines to ours, so here’s hoping the committee listens and acts on the recommendations of the majority.

A stroke can be devastating condition and is the third most common cause of death in the UK; 11,000 people have a stroke in Wales each year.

Strokes leave one third of patients permanently dependent on the help of others and is the biggest cause of severe acquired disability in the UK.

The treatment and management of stroke is now supported by a good body of quality evidence and we have witnessed a number of medical advances in recent years. As a result acute stroke is increasingly becoming a treatable condition.

That’s one of the reasons why BMA Cymru Wales welcomes the Welsh Assembly Government’s decision to make improving stroke services a priority - as a result the last few years have seen improvement in stroke care across Wales. However so far, this has not gone far enough. In almost every area of stroke care Wales lags behind that of England and Northern Ireland. There are pockets of good practice but the patchy provision of services across the country indicates that much more needs to be done.

If we are to see real improvement in the treatment and services available to stroke patients across Wales, the WAG needs to take act on the points listed below;

• A Wales-wide doctor recruitment and retention strategy, with an emphasis on specialist stroke physicians and neurologists.

• Everyone in Wales should have access to a stroke unit within 30 minutes travelling time of their home and the units should;
* Offer round-the-clock care with access to thrombolysis and scanning equipment
* Be adequately staffed (doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians, psychologists, social workers)
* Have adequate bed capacity
* Have strong links with rehabilitation and support services

• The new LHBs should:
* Make it someone’s responsibility to lead the team and champion the improvements within their areas and offer local solutions;
* Greatly increase the number of whole time equivalent medical hours allocated to stroke treatment and management;
* Work closely with local authorities and others to create multi-disciplinary care partnerships ensuring joined up working and continuous care provision;
* Interpret national guidance into effective local delivery by considering what is best to meet the challenges of that particular area. In this way national guidance should be broad and flexible;
* Facilitate research and data gathering through, for example, local clinical research networks - working with other LHBs to take a Wales-wide view of stroke services;
* Utilise the new Professional Forums and Stakeholder Reference Group as a mechanism to highlight stroke issues.
* Facilitate public awareness and education campaigns.

• Given the importance in receiving treatment immediately after a stroke, people should be directed straight to hospital, ambulance staff should be specially trained in the early treatment of stroke victims, and information should be sent to GPs to support direct referral.

• A national public awareness campaign is needed to highlight the prevalence and severity of stroke, how to recognise the symptoms, and that it requires a 999 response. The FAST (Face, Arms, Speech, Time) campaign did some good work in relation to this but needs to be built on – for example, the ways to recognise transient ischaemic attacks (TIA), the risk factors such as high blood pressure and diabetes, high cholesterol, smoking, excess alcohol intake and recreational drug use should also be highlighted. Many people still do not realise that strokes are preventable, do not know the symptoms or risk factors, or how to manage them.

• A training programme should be developed for stroke treatment across the multi- disciplinary teams working within the primary and secondary care sector to ensure efficiency and confidence when treating or managing stroke. Training should also be extended to carers.

• The long-term impact of stroke on families and carers needs to be looked at and their views sought.

• Current policy on Stroke - the National Service Framework for Older People, the Stroke Improvement Programme and the Stroke Pathway – are useful but we also support the development of a Stroke Strategy for Wales accompanied by a solid and achievable Action Plan.

Surgeons’ overtime bill highlights more deep-rooted problems within the Welsh NHS

The front page of the Western Mail today highlights an issue that has been of concern to BMA Cymru Wales for some time - the need to adequately staff the Welsh NHS.

The over-reliance on overtime and private hospitals to try and ensure waiting time targets are met, is merely using a sticking plaster to patch up what is a much more serious problem. There has been insufficient investment in the NHS in Wales over the last few years, with the default position becoming one of buying additional capacity through short-term schemes. Surgeons do not work on their own, they’re part of a team, including anaesthetists, nursing and other clinical staff. Extra resources are therefore needed to manage these issues long-term, with the employment of more surgeons, anaesthetists and nurses.

NHS staff are being pushed to the limit to deliver the 26-week access targets by December, set by the Welsh Assembly Government. Added to this is the impact of the European Working Time Directive, introduced in August, with many doctors being encouraged to work above the 48-hour limit set by this legislation.

It may not be what either politicians or patients want to hear, but if the current financial pressures do not allow for the NHS in Wales to be better resourced, then maybe it’s time for the WAG to scrap targets, as without extra resources, quality of care will undoubtedly suffer, which certainly isn’t in the best interests of patients or doctors.

Scrapping GP catchment areas – superficially attractive but not essentially practical

Good to hear that this isn’t a priority for the Welsh Assembly Government as the BMA can see many drawbacks to the idea of scrapping GP catchment areas.

For a start, the rest of the health service and social services and county councils all work by boundary areas, and so to just suddenly take general practice out of that system, would be terribly complicated and actually very difficult to make work.

It would be hard for patients to access a doctor in more rural areas - how would they get home visits when they are ill, if they are registered miles away, near their place of employment?

Also what would happen to practices that are destabilised because some of the younger, healthier patients have gone elsewhere? Surgeries with a mix of patients, where some don’t visit their doctor that often, help general practice to be cost-effective. If younger people register near their workplaces, some practices could be left with patient lists mainly composed of those with long-term conditions and complex illnesses, severely disadvantaging some practices.

We do support boundaries being a little more flexible, so long as practice organisation isn't interfered with. We also support practices trying to make it as easy as they can for patients to see their regular doctor whenever possible. Our main concern though is not to disadvantage the most vulnerable, which these changes could possibly lead to.

So for the Department of Health to argue that the main reason for scrapping GP surgery boundaries is to increase patient choice, is in essence a false one, with many surgeries perhaps having to close as a result of these changes. This seems to be change for the sake of it.

Posted on behalf of Dr David Bailey, Chair of GPC Wales.

A ban on violent patients doesn’t seem so "understanding"

And just to add to my earlier blog post on violence and aggression, whilst we support the memorandum of understanding, we wouldn’t go as far as calling for people who are violent towards NHS workers to be banned from using frontline services, which is what Barbara Wilding, the Chief Constable of South Wales police seems to be advocating. A tougher approach is needed, we definitely agree with that, but to try and prevent people from accessing NHS services would be a potential violation of their human rights and goes against the very ethos of the NHS – health services accessible to all. Better surely that we focus on the points made in my earlier blog than to be so draconian?

More than just understanding is needed to tackle violence and aggression in the Welsh NHS

This development is a step in the right direction and should help with the investigation and prosecution of alleged attacks against doctors and the wider medical profession.

Action to show people that violent behaviour will not be tolerated is long overdue with the problem becoming more widespread. More than 7,000 incidents were reported in the NHS in 2007-08. It is also an area that we have been calling for action for several years now, having been made aware of many incidents where our members have been victims of violence and aggression. As far as BMA Cymru Wales is concerned, it is totally unacceptable and inexcusable to attack a doctor, or any healthcare professional in the line of duty, when they are trying to ensure the good health and well being of patients.

There is still much to be done in completely stamping out this problem, which, to many of our members is sadly becoming part of the norm of their daily working lives.

To stand alongside this memorandum of understanding, BMA Cymru Wales is calling for the following;

• A register of violent patients - If a doctor, nurse or other healthcare personnel can be alerted in advance to the possibility of a patient becoming violent, s/he will be forewarned and no longer placed in a position of vulnerability, through a lack of relevant information.

• Training and Communication - Ensure that all staff are fully trained and are aware of the mechanisms to report physical or verbal abuse and that they are encouraged to report incidents.

• Staff Support - Ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident.

• Public Awareness - Patients and healthcare users need to know that they are not outside of the law while in contact with healthcare professionals and that those offenders will be brought to justice.

If these measures are brought in to force as well, then we really could be well on the way to eradicating this, unfortunately, growing issue.

The WAG could be storing up a whole heap of problems over a lack of GPs

It seems as if nothing has changed yet then in terms of the future of the GP workforce in Wales, or if it has, it’s only a change for the worse. The latest round of “Workforce Statistics for General Practitioners in Wales, 1998 – 2008” just serve to highlight how much of a ticking time bomb Wales is sitting on when it comes to having enough GPs to serve the population. Put simply, the figures show how those GPs coming up to retirement age aren’t being replaced by younger doctors. I blogged on this particular issue earlier this year and so these stats just back up everything I said then.

There are several reasons as to why Wales may soon be facing a GP shortage, a key one being demographics, with lots of older, single-handed GPs coming up to retirement age in the valleys. Also in Wales, GP incomes are lower than their counterparts in England, but with a higher workload than England. There may also be less opportunity for surgery partnerships in Wales. Then of course, there has been the trend over recent years (and rightly so) for an increased emphasis on work/life balance, making it easier for more GPs to work part-time.

And just as there is no one reason, there probably isn’t one easy solution to what could be a very serious issue in the coming years. The reorganisation of the Welsh NHS is due to really come into effect over the next few weeks, which sees a greater emphasis on the role of GPs and primary care, so it really is about time that the Government here starts taking the recruitment and planning of the Welsh GP workforce seriously. Otherwise, as the old classic song goes "There may be trouble ahead..."

Calling time on alcohol promotion

The BMA has launched a new report today looking at the effects of drinks promotions, particularly amongst young people.

We’re calling for a total ban on alcohol advertising, including sports events and music festival sponsorship as well as promotional deals like happy hours, two-for-one purchases and ladies’ free entry nights.

“Under the Influence”, also renews the call for other tough measures such as a minimum price on alcoholic drinks and for them to be taxed higher than the rate of inflation.

Over the centuries, alcohol has become established as the country’s favourite drug. But the reality is that young people are drinking more because the whole population is drinking more and we now see pro-alcohol messaging, marketing and behaviour everywhere. In treating the issues around drink, we need to look beyond just young people and at society as a whole.

According to the World Health Organisation, alcohol is the leading risk factor for premature death and disability in developed countries, after tobacco and blood pressure. It’s related to over 60 medical conditions, costs the NHS millions of pounds every year and is also linked to crime and domestic abuse.

Alcohol consumption in the UK has increased rapidly in recent years. Household expenditure on all alcoholic drinks increased by 81 per cent between 1992 and 2006. At the same, never before has it been so heavily promoted.

The drinks industry spends £800 million a year in promoting alcohol in the UK. So it’s little wonder that we see it everywhere – on TV, in magazines, on billboards, as part of music festival or football sponsorship deals, on internet pop-ups and social networking sites. Given that teens often don’t like the taste of alcohol, new products like alcopops and toffee vodka are developed and promoted because they have greater appeal to young people.

The BMA is not calling for a ban on alcohol. As doctors, our focus is to ensure that individuals drink sensibly, so they don’t put their health and lives in danger.

There was a time when it was regarded the norm to see cigarette adverts and people smoking on buses, trains, airplanes and in restaurants. When the BMA initially called for a ban on smoking in all enclosed public places, there was a general outcry about it. But I doubt most people would want to return to the days of smoky pubs now. There has been a cultural change for the better and this now needs to happen with alcohol.

As this report points out, it would seem that brand development and stakeholder marketing by the alcohol industry, including partnership working and industry funded health education, have served the needs of the alcohol industry, not public health.

We have a perverse situation where the alcohol industry is advising our governments about alcohol reduction policies. As with tobacco, putting the fox in charge of the chicken coop – or at least putting him on a par with the farmer – is a dangerous idea. Politicians showed courage before by not bowing to the tobacco industry, they need to do the same now and make tough decisions that will not please alcohol companies.

Key recommendations from the report include:

• There should be a ban on all alcohol marketing and promotion
• UK governments should establish minimum price levels for the sale of alcoholic products
• Tax increases on alcohol should be set above the rate of inflation and be linked to the alcoholic strength of products
• A reduction in licensing hours for on- and off-licensed premises should be introduced

Read the report in full - “Under the Influence – the damaging effect of alcohol marketing on young people”

Juniors affected by exams mix up need our support

This really is an awful situation that these four young people are currently faced with and it’s very difficult to imagine how they must be feeling right now. That’s why BMA Cymru Wales will be doing everything possible to offer as much help and support as we can to get them through this.

Rest assured too, we will be seeking answers as to how such a fundamental error occurred and what changes will be made to make sure such serious mistakes are not repeated. However, at this moment in time, the key focus of our efforts is to ensure that those involved receive all the support we can provide.

Don’t delay in getting children protected against measles

I couldn’t agree more with this Western Mail article and the need to make sure children have been vaccinated against measles before the start of the new school year in Wales, in a few weeks time.

It’s only two counties in Wales which aren’t affected by measles, and with around 45,000 youngsters currently unprotected, this outbreak is only likely to get worse when schools go back after the summer holidays.

I have blogged on here before about the need for children to be vaccinated, particularly those who’re school-age and how damaging the unfounded allegations about the MMR jab from several years ago were, with the effects still it seems being felt today. So I think the need for a concerted drive to increase public awareness about the common misconceptions associated with the MMR jab has never been greater, as September approaches.

EWTD highlights the growing need for BMA Cymru Wales’ Option 7 Campaign

This Sunday Times article just goes to show how important and timely BMA Cymru Wales’ Option 7 Campaign is. Although this article refers to Scotland, the situation is more than likely being replicated in other parts of the UK. The Option 7 Campaign (named after the option on the BMA hotline) was originally set up because we were hearing of instances of intimidation/harassment/bullying of junior doctors before the introduction of the European Working Time Directive (EWTD) and chances are this has just exacerbated things. EWTD stipulates that juniors must not work more than 48 hours a week, but there are of course easy ways to get around this legislation, such as juniors being told to under report the amount of hours they are clocking up in any given week.

The European Commission must do more than “threaten” to investigate these allegations highlighted in The Sunday Times, it has a duty to do so, for the safety of both patients and NHS staff.

Junior doctors in Wales can also report their concerns to the BMA and they don’t need be a member to do so. Any information given will be kept completely confidential. Help us to help juniors by ringing the BMA on 0300 123 123 3 and select option seven.

Show your support for the Option 7 Campaign on facebook too, by joining one of our groups, follow the links below.

BMA Cymru Wales Option 7 Campaign facebook group

BMA Cymru Wales Option 7 Campaign Supporters of junior doctors facebook group

Tamiflu isn’t a wonder drug

This piece of BMJ research certainly grabbed the attention of the media yesterday. Though at the moment, anything to do with flu seems to get picked up on and linked to swine flu in some way.

As the research itself actually details “it is difficult to know the extent to which the findings can be generalised to children in the current swine flu pandemic but, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited.”

This is not to say that all children should not be given anitvirals like tamiflu. What perhaps we need to bear in mind is that we are learning more about antivirals, the more we use them. And while we know they are safe, we also know that vomiting and diarrhoea can occur in some children and adults who take them.

GPs have always said that doctors need to balance the risk of major complications from swine flu and the risks of side-effects from antivirals.

The more we learn about these drugs the more we will know how to treat patients with the most up-to-date clinical evidence. Tamiflu has a place in dealing with and containing the spread of swine flu, but it’s not a “cure all”.

Action not words now needed on organ donation

Around 30* people will have died in Wales in the last year, waiting for a transplant on the organ donor register.

That's why BMA Cmyru Wales is calling for action to be taken by the Welsh Assembly Government with regard to possible changes to the organ donation system.

It’s also a year since the Assembly’s Health Committee rejected any ideas to change the organ donation system in Wales.

This led to the Welsh Assembly Government’s wider consultation on the matter, which has just closed.

We submitted a response to this consultation, reiterating calls for a “soft” system of presumed consent to be introduced and to do so sooner rather than later, before more lives are lost.

There are several reasons why the BMA believes that such a system would produce a far higher potential donor rate than at present and in turn, save more lives.

The main difficulty with the current system is that where, as in the majority of cases, relatives do not know what their loved ones wishes are, they frequently, and understandably, opt for the default position, which is not to donate. This would be addressed by the introduction of an opt-out system where the default position would change in favour of donation. We recognise this is a subject many people hold strong views about and as such, those who do not want to donate their organs will sign up to opt out.

The number of people on the organ donor register has doubled since 2001, from 8 million to more than 16 million. But 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.

Presuming consent rather than presuming objection is also more likely to achieve the aim of respecting the wishes of the deceased person. Given the very high level of support for organ donation expressed in repeated surveys (up to 90%) 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. With such a shift towards making donation the default position this reflects a positive view of donation, demonstrating the very strong support for it within society. Therefore, over time donation would come to be seen as the norm, rather than the exception.

Added to this is the fact that there is significant and growing public and professional support for such a shift. Recent public opinion polls show around 60-70% support for a shift to an opt-out system of consent for organ donation. This is consistent with the views found in the Assembly’s own public engagement exercise.

The time really has come, before more people die waiting in vain, the Welsh Assembly Government needs to stop procrastinating and seek an LCO (Legislative Competence Order) from Westminster to bring in a soft system of presumed consent.

*The figure of 30 people dying in the past year in Wales is based on 150 people dying in Wales waiting on the organ donor register in the last 5 years.

New Option 7 Campaign facebook group - for supporters of junior doctors

In addition to the last bog post, unveiling the launch of BMA Cymru Wales' Option 7 Campaign, we have now set up an additional facebook group, for friends/ colleagues/ family members of junior doctors in Wales to show their support for the cause.

Join the BMA Cymru Wales Option 7 Campaign - supporters of junior doctors facebook group and post your message of support too.

And thanks to everyone who has already joined the group(s) and are supporting our campaign!

The Option 7 campaign – to improve the lives of junior doctors in Wales

BMA Cymru Wales is today launching a campaign aimed at improving the working lives of junior doctors in Wales.

It’s previously been touched upon on this blog, but we have now become extremely concerned about the working conditions of junior doctors and the impact that this could have both on careers and on patient safety. This includes;

• Lack of training opportunities
• Unsafe staffing levels
• Bullying/ intimidation
• Non-compliant rota/ rota gaps
• Insufficient locum cover

Junior doctors are understandably afraid to voice any concerns themselves with senior management, for fear of repercussions.

So that’s why BMA Cymru Wales is launching the Option 7 campaign - named after the option on a BMA phone line that juniors can select, to discuss bullying and harassment in confidence.

The on-going campaign will involve myself and BMA Welsh council chairman Dr Andrew Dearden meeting with the chairs and chief executives of the new NHS health boards in Wales.

We are hearing of some worrying cases concerning junior doctors, which seem to be more widespread than just “one-off” incidents. I do think it has got to the point where it is starting to affect the reputation of training in Wales.

It is vitally important that we get the message out there that this type of behaviour cannot and will not be tolerated, no matter what the source, either from management or clinical staff.

In the meetings with NHS health board managers (chief executives and chairs), we will be offering support to employers to resolve the problems highlighted and drawing up an action plan of;

• What exactly will be done to address the issues
• Who will take responsibility for making sure action is taken
• Setting deadlines for action and resolving problems raised in these meetings

We will also be meeting as many junior doctors as possible during the campaign.

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.

View Dr Andrew Dearden and Dr David Samuel (chairman of the BMA's Welsh Junior Doctors Committee) talking about the campaign on BMA Cymru TV.

And follow the campaign updates on Twitter.

Action needed now to stop NHS Wales becoming unsafe for staff and patients

Unless urgent action is taken to plug the gap in the shortage of middle grade doctors, the NHS in Wales could become unsafe both for staff and patients.

The problem‘s been highlighted this week within Hywel Dda NHS Trust, where 62 posts remain vacant.

But this situation is by no means isolated to Hywel Dda, with Abertawe Bro Morganwg Trust having had to move some specialist services because they were inadequately staffed. Similar problems are also affecting North Wales too.

We are facing unprecedented levels of a lack of middle grade and junior doctors right across Wales, which is clearly unacceptable to both our members and people needing hospital treatment and this does not look like changing in the immediate future.

There are a variety of reasons for this shortage, one being that Wales does not top the list of places where many junior doctors desire to work. Also, changes to the rules regarding immigration have caused problems with recruitment across the whole of the UK, not just Wales.

The high level of middle grade and junior doctor vacancies means that consultants are left picking up the pieces where there are gaps in rotas. This is compromising consultants’ ability to deliver routine daily work and there is no evidence that hospitals are adjusting services to take these shortfalls into account. Inevitably, the rates of work being undertaken cannot be sustained with the current levels of staffing. Hospital managers really need to address this now, working with clinical colleagues.

These problems come as no surprise however to us at the BMA, having predicted that these shortages would happen at some point. That is why we have, for some time now been trying to meet with representatives from the Welsh Assembly Government, to see how we can work together, drawing on the experience of front line doctors, especially juniors, to look for some solutions to the situation.

BMA Cymru Wales has also worked in partnership with the Wales Deanery for Postgraduate Medical and Dental Education, to produce a DVD for students, giving an invaluable insight into medical training here.

The aim of the video is to promote Wales as a primary destination to study medicine and to attract more junior doctors to apply, to complete their postgraduate training here. However, the positive effects of this will not be seen immediately.

The initiative to provide free accommodation for F1 doctors has been welcomed by BMA Cymru Wales and has had some impact. Yet, I think far more effort should have been put into anticipating and planning for the current shortages, especially the impact of the European Working Time Directive which has been known about for more than 13 years! Whilst it is very late in the day, I urge the Welsh Assembly Government and employers to focus on the actions we have been highlighting for some considerable time. I do not think sufficient, co-ordinated efforts to recruit and retain doctors to Wales has been made.

While in the short term, we have to have contingency plans put in place as soon as possible to ensure the safety of both NHS staff and patients, we need far more sustainable solutions if NHS Wales is to deliver and maintain the quality and capacity of services the people of Wales deserve.