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.

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.

Wales could lead the way…..

Plaid Cymru MP Hywel Williams has laid an early day motion backing Wales’ decision to explore moving to a system of presumed consent. It says:

“That this House welcomes the announcement by the Welsh Assembly Government that Wales will move to a system of presumed consent, based on a soft opt-out system for organ donation; congratulates the patients and organisations, led by the Kidney Wales Foundation, on persuading the Welsh Assembly Government to take this step; recognises the overwhelming public support for such a move; and, following a free vote in the National Assembly for Wales, looks forward to supporting that move in this House, alongside a strengthened infrastructure to support the change.”

View the signatories here

This EDM has good cross-party support, and I hope to see more signatures added to the list over the next few weeks.

I’m glad that the Welsh Assembly Government are willing to take the lead, and send a clear message to the rest of the UK that a 'soft' system of presumed consent would increase donation rates and save Welsh lives.

BMA Cymru Wales believe that moving to a system of presumed consent, where it is assumed that people are willing to donate their organs after death unless they opt out, combined with other reforms to the transplant infrastructure, would play an important part in improving the organ donation system so that more lives can be saved.

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 fact is, that people are dying while waiting for an organ transplant. It is vital therefore, that we increase the number of donors available, and we believe that a system of presumed consent with safeguards will do this.

A shift towards making donation the default position would reflect a positive view of donation, demonstrating the very strong support for it within society today. Therefore, over time donation would come to be seen as the norm, rather than the exception.

BMA Cymru Wales want what's best for patients, and ensuring a supply of organs that will meet current and growing demand must remain our ultimate goal.

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.

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.

Wales is right to opt out of swine flu helpline – for now

Looking at some of the media coverage over the weekend and the past week in fact, it only serves to reassure me that Wales is right so far, to opt out of the National Pandemic Flu Service, now operating in England.

The Chief Medical Officer for Wales, Dr Tony Jewell, attended a meeting of our GP committee last week to keep us up-to-date with what’s happening and it was agreed by everyone how well GPs and primary care are coping at the minute, as well as our hospitals - hence why we don’t need to be signing up to the flu service just yet.

The focus in Wales is to ensure that cases of swine flu, or potential cases are clinically managed and advised. This is likely to best achieve what everyone wants - clear advice and guidance, the most accurate diagnosis, and the right treatment at the right time, but not to be treated unnecessarily, or to be treated for the wrong condition.

It really is important to keep perspective on this as I mentioned here last week and to not be sucked in by the scaremongering which seems to be going on in certain areas of the media. Despite an increase in cases of swine flu in Wales, the number is still at a level that would be considered normal for flu in the winter, in others words, nothing GPs and our helath services don’t deal with every year.

Tamiflu, the ant-viral drug being prescribed for swine flu is not without side-effects, such as nausea, insomnia and irritability. As most people who’ve had swine flu report it as being no worse than a bad cold, for the otherwise healthy the treatment maybe worse than the disease and symtomatic treatment alone is all that is necessary. That doesn't of course apply to those in the at risk groupS, where Tamiflu would be indicated. But everyone is different and the decision to treat should rest between patient and doctor, as always.

What we need to ensure in Wales, is that the right decisions are made by independent and experienced health professionals, as is happening currently. That's not to say that things won't change and use of the "Flu-Line" will be welcome. However BMA Cymru Wales has faith in the Chief Medical Officer to make the right decisions for the people in Wales, at the right time, as the Chief Medical Officer and the Welsh Assembly Government has faith in GPs in Wales to deliver for their patients.

ARM – day two - Chair of Welsh Council addresses conference

Dr Andrew Dearden, Chair of Welsh Council has opened day two of the ARM, in Liverpool.

In his address, Dr Dearden has just delivered an update of BMA Cymru Wales’ work over the last year, outlining the new-look Welsh NHS. He views the last twelve months as a success for the BMA in Wales, in engaging with both the profession and the public as well of course, as representing members.

A packed conference hall loudly applauded at the mention of the Welsh Assembly Government’s commitment to free accommodation for junior doctors, and at the wise and more enlightened approach the WAG has taken "to build a health service free from commercial pressures, free from competition and free from private, profit driven provision."

As Dr Dearden adds "We are also now beginning to see real benefits of political devolution. The health service in Wales remains true to the ideals of its founder, even if they have been forgotten or deemed irrelevant elsewhere".

But, it doesn’t end there. As we know the health service in Wales is far from perfect, and those working within it are facing fresh and difficult challenges. The historic legacy of under funding health in Wales, coupled with higher levels of disease and deprivation, is hard to overcome. That is why the current NHS re-organisation has to work, we can’t afford for it not to. And with proper and constructive clinical engagement, it will.

Our current focus is on the plight of Junior Doctors and Medical Students in Wales which we will be doing a lot of work on over the next year and beyond if necessary.

Dr Dearden told conference: "We will drive home our message to both hospital managers and politicians, that the effective training of junior doctors and medical students is not a luxury – it is not an optional extra, expendable in the face of targets, it is one of the most critical components for the future success of the NHS in Wales and the UK".

Dr Tony Calland, former Chair of Welsh Council, followed Dr Dearden’s address, putting forward a motion on IT in the Welsh NHS - another area where we seem to be leading on (it’s not often that a BMA Council proposes a motion praising Government – a fact that Dr Calland also recognised in his speech!) He states that WAG has taken a thoughtful and pragmatic approach to modernizing medical IT systems, and has worked closely with the profession to develop it – which is the key to its success, I’m sure.

It’s time for a lunchtime break and a quick walk around the Albert dock, preparing for this afternoon’s agenda which includes community care, mental health, safeguarding children and forensic medicine.

More to follow...

Kicking off the ARM with a call to "Look after our NHS"

Day one of this year’s ARM in Liverpool began with BMA UK Chairman Dr Hamish Meldrum’s key address to delegates. The hall’s packed with around 500 doctors from all over the UK.

In his speech Dr Meldrum called on the Westminster Government to “end this ludicrous, divisive and expensive experiment of the market in healthcare in England.” He urged doctors to sign up to the BMA’s “Look After Our NHS” campaign which is gathering examples of how the market is impacting on the NHS. To much hand-clapping, he said there was never a better time to abandon market reforms in England.

In Wales, thankfully we have a Government in the Assembly that has rejected the internal market in healthcare and the commercialisation of the NHS. This has been continued, rightly so, in the recent reform programme.

As I listen to doctors from England who tell me their priority and loyalty to patients and patient care is being compromised by the need to meet tough and arbitrary financial targets, I am grateful to be a doctor living and working in Wales.

The NHS is facing some of the biggest and most serious challenges ever, as we move from a period of sustained growth in resources to one of, at best, stagnation in funding, and at worst, stringency, hardship and even cuts, in our health service.

Although the NHS in Wales has its own challenges, the concerns that I have listened to so far from doctors practicing in England go against the core principles of our health service. The Welsh Assembly Government certainly face serious challenges and criticisms in other areas, but rejecting commercialisation in our NHS is one very important thing that they have got right. Our NHS is and has to remain – Publically Funded, Publically Provided and Publically Accountable.

I will leave you with a quote from Dr Meldum’s address:

“We need to do everything possible to protect the healthcare budget and not concede that swingeing cuts are either inevitable or necessary… The profession is ready to work with whichever governments are in power, to look at the hard choices, to make the tough decisions on the basis of evidence, fairness, equity and trust … We need a whole-system and across-government approach to improve the health of the public, with every citizen involved …Only that way will we slow the inexorable rise in pressure on our National Illness Service and cope with the financial and clinical challenges that lie ahead.”

Watch this space, there’s plenty more ARM coverage to follow...

Will Government finally act on regulating the sunbed industry?

More support today for the BMA’s calls to get the tanning industry better regulated. The independent government advisory committee Comare (Committee on Medical Aspects of Radiation in the Environment) says the current system, where the industry is self-regulated, is inadequate on public health grounds.

The committee’s making several recommendations to Government, many of which we’ve been wanting to see happen for a long time.

These include;

Preventing the use of sun beds by children
Ensuring that sun bed users are supervised
Ending the use of coin-operated machines

The question is, will the UK Government act on these recommendations and actually finally do something about regulating the sunbed industry properly?

Welsh Pharmacy Awards 2009

Last night I attended the Welsh Pharmacy Awards at Cardiff's City Hall. This was the first ever event of its kind hosted by the Welsh Chemist Review - a publication for pharmacists produced by Medical Communications Limited, based in Northern Ireland. Similar hosted events take place in Northern Ireland where GPs are also recognised for their service. It is so important that the role and contribution of health professionals in Wales are recognised and I hope that the outstanding achievements, service excellence, innovations and developments that are taking place in community and hospital pharmacy receive wider recognition. I have always enjoyed excellent working relationships with both my hospital pharmacy and community colleagues and have always valued our collaborative working for the benefit of patients.

It will be vitally important for the patients of Wales that all healthcare professionals work in harmony in the light of the forthcoming NHS reforms in Wales, and the tighter financial position that we are frequently warned of. Primary and community care is intended as the key focus for healthcare delivery, although it is inevitable that patients require specialist hospital intervention too. The only thing that matters to patients is that all these services including social care are provided at the right time in the right place and to the highest possible standards, consistently and reliably. This can only happen when all those professionals involved in the provision of health and social care work together effortlessly, respecting each others roles and skills.


Note:

The categories & nominations were:

This year there were 8 award categories:

* Business Development of the Year
* Innovation in Service Development
* Managing Healthcare Services in the Community
* Pharmaceutical Care
* Pharmacy Support Staff Training
* Pharmacy Technician of the Year
* Community Pharmacist of the Year
* Hospital Pharmacist of the Year

Nominations

* Business Development of the Year Award
Andrew Mather, Fferyllfa Newport Pharmacy
Christine Campbell, St Athan's Pharmacy
Phil Bullen, Wellness Pharmacy

* Innovation in Service Development Award
Sarah Louise Blood, Wrexham Maelor Hospital
Ceri Williams, Rowlands Pharmacy, Porthmadog
Cherrie Temple, Boots UK, South Wales
Lloyds Pharmacy, Sway Road, Morriston

* Managing Healthcare Services in the Community Award
James Jenkins, The Co-operative Pharmacy, Rhondda Cynon Taff
Alexander Daghlian, Alexanders Pharmacy, Wrexham
Alison Sparkes, Sparkes Pharmacy, Neath
Lloyds Pharmacy, Marsh Street

* Pharmaceutical Care Award
Anita White, Wendy Griffiths Pharmacy
Rhodri Jenkins, The Co-operative Pharmacy, Pontycumer, Bridgend
Ruth Mitchell and the Pharmacy Team, Boots UK, St David's Centre, Cardiff
Sion Llewelyn, Rowlands Pharmacy, Bala

* Pharmacy Support Staff Training Award
Alexander Daghlian, Alexanders Pharmacies Ltd
Asda Stores, Pontprennau
Carol Hudson, Lloyds Pharmacy Gelligaer
Rowlands, Runcorn

* Pharmacy Technician of the Year Award
Melissa Roberts, Rowlands, Gwynedd
Catherine Daghlian, Alexanders Pharmacies Ltd
Kelly Hann, Lloyds Pharmacy, Morriston

* Community Pharmacist of the Year Award
Alwyn Fortune, The Co-operative Pharmacy
Ceri Williams, Rowlands Pharmacy, Porthmadog
Daniel Charles Jenkins, Lloyds Pharmacy, Port Talbot
Mike Wallington, Boots UK, Cardiff

* Hospital Pharmacist of the Year Award
Farzana Mohammed, Royal Gwent Hospital
Sarah Louise Blood, Wrexham Maelor Hospital
Sian Evans, Velindre Cancer Centre
Richard White, Glan Clwyd Hospital

Organ donor public debates test opinion on presumed consent

My Policy and Public Affairs Officers attended one of the many Welsh Assembly Government public debates this week, examining the question of 'presumed consent' for organ donation.

The BMA has long-argued the need for a fundamental shake-up in the way organs are donated. We have some 500 people in Wales waiting for a donation.

What I can't quite get my head around is the fact that if you ask people, the majority will say they support organ donation. In fact, some 90% say they would be willing to donate. Unfortunately, this does not translate into people who actually sign the register - it stands at roughly 30%.

So we have a problem. The BMA believes that we need to adopt a 'soft' system of 'opt-out' or 'presumed consent'. It's a subtle difference but an important one. People would still be able to opt-out if they have a moral or religious objection but it would help those people who for, whatever reasons, do not get round to registering.

Families would also have a final say. Which is why Kidney Wales' recent "Tell a Loved One" campaign, is so important. You can sign up to the organ donor register and carry a card, but if your nearest and dearest don't know your wishes, they'll be less inclined to follow them out if you haven't discussed organ donation with them first. And as next of kin would have the final say, they could go against your wishes, if you haven't bother to tell them.

Unfortunately, there's still a great deal of mistrust from the public and I still despair when I hear people saying that this is an attempt by the 'state' or 'politicians' to 'take my organs'. I really don't think that this is the case. Doctors just want what's best for their patients, and ensuring a supply of organs that will meet current and growing demand must remain our ultimate goal.

Anyone wanting to register to be an organ donor, can do so here