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.

“Wales may be a small country but it has a lot going for it” – Christine Chapman AM

How we get the next generation of Doctors to train in Wales continues to be a major issue and one which is not new for the BMA.

Representing an area which has traditionally suffered from high levels of health inequalities, over the last ten years I do think that we can talk up the achievements that have been made in Cynon Valley. We’ve got more salaried GP’s than ever which has helped to solve the recruitment problem we once had, new, modernised surgeries are clearly visible and in Spring 2011 the new Community Hospital in Mountain Ash will open its doors.

Across Wales, there is a choice of high quality facilities which provide first class training and education. But while clinical experience is very important, so too is the life experience.

I do think that what is attractive to those who have studied in England, particularly in the big cities such as London, is the quality of life on offer in Wales. Whether you are looking to continue with the city life or a more rural environment, Wales has much to offer. Generally house prices are lower and everyday living costs are more reasonable. In my own area, the Valleys have great opportunities for outdoor recreation, cycle trails, quad biking, mountain climbing and also its close proximity to Cardiff. Wales may be a small country but it has a lot going for it.

Christine Chapman AM Cynon Valley
Labour

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.

Swine flu vaccine agreement reached for Wales

Agreement for a swine flu vaccination programme to be rolled out by GPs across Wales, I am pleased to say, has been reached.

General practice is an efficient and adaptable model that reaches into every community in Wales and is best placed to deliver the vaccination. GPs are used to delivering large scale vaccination programmes that target patients at highest risk and this agreement means that GPs and their teams will have the resources they need to take on the additional workload and run the vaccination programme smoothly and efficiently.

This agreement is testament to the cooperative work we have produced with the Welsh Assembly Government and our GP members look forward to delivering the protection for vulnerable groups that the people of Wales deserve.

Revalidation in Wales

Just to make you aware of a revalidation event which BMA Cymru Wales is organising, to be held in Cardiff on October 21st 2009.

Chairman of the General Medical Council, Professor Peter Rubin will be speaking at the event and wants to hear doctors' views about how revalidation should be implemented in Wales.

This event is open to ALL doctors (whether a BMA member or not)in Wales.

If you would like to attend please email BMA Cymru Wales CEO Sarah Miller - smiller@bma.org.uk

It would be good to get as many doctors there as possible, to get a wide range of views.

More warnings over health risks linked to alcohol

Health warnings in the news again concerning alcohol, but this is one that is perhaps not so well known. How many of us actually realised that drink could be linked to oral cancers? Cigarettes - definitely. But alcohol? It’s usually liver disease that is seen as being the number one health problem associated with alcohol, so could that soon be superceded?

It seems this is yet another reason for why drink should be consumed in moderation and to not accept the “binge drinking” culture that is so much the norm in the UK. This report from Cancer Research UK highlights that about three-quarters of oral cancers are thought to be caused by drinking alcohol and smoking.

The BMA has often outlined how doctors witness the devastation of alcohol on patients and the crippling effect it has on the NHS. So what price could we all soon be paying for the treatment of this huge increase in conditions like mouth cancer?

Just last month we repeated our calls at the BMA’s annual conference to have a minimum price for a unit of alcohol introduced by the UK government, partly because of the increased burden of alcohol-related diseases and complications on our nation’s health.

All the following points were agreed upon by members in July.

We…

ii) believe that a minimum pricing strategy would not unduly disadvantage responsible alcohol consumers;
iii) call for all alcoholic beverages to have clearer labelling indicating alcoholic content and unit value;
iv) call on the BMA to lobby government for a total ban on alcohol advertising in the media;
v) demand that revenue obtained from increased prices should be used for the prevention of alcohol misuse and the rehabilitation of alcohol abusers.

And reports like this one today just add more ammunition to our fight.

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”.

Employers need to keep us informed as swine flu spreads, to stop NHS Wales from grinding to a halt

As swine flu continues to grip the UK, everyone is looking to the health of the public, which is of course only right. I think there is also though an urgent need to look at the implications for health staff and how services can be best managed to ensure they can cope with the demand. There is an enormous amount of planning and logistics going on behind the scenes to "keep the show on the road", but sometimes it is the practical matters that need to be clearly communicated - and that make all the difference. Some of the issues raised by BMA Members that need clarity and that we are raising with Welsh Assembly Government and employers include:

Medical rotas

I know that, while many medical rotas are EWTD compliant on paper, they rely on doctors’ good will to undertake additional duties for their effective operation. As such there is a real risk that these rotas will become inoperable due either to sickness among the doctors on the rota, or those doctors being redeployed to other duties. When (or hopefully in advance of) these rotas are on the point of falling apart, who makes the decision to either suspend their normal operation or combine them with other rotas or otherwise? Clarity is needed.

Routine clinics

Routine clinics may need to be cancelled, either from general population illness or patient reluctance to attend (particularly those clinics serving patients who may be immuno-compromised). How are medical staff to be redeployed, inevitably at short notice and for short periods, and who will make those decisions?

Reporting arrangements

The reporting arrangements (who to telephone, etc) when medical staff become symptomatic (and with whom to discuss their symptom severity) do not seem to be that well known, together with consequential advice on recommended absence periods before returning to work. How are employers communicating this message?

Medical staff in high-risk groups

Appropriate advice for medical staff who may be in high-risk groups (especially those who are pregnant) is as currently topical for them as for the general population. What steps are employers, through their occupational health services or otherwise, taking to risk-assess these members of staff and to deploy them to appropriate duties?

BMA Cymru has raised these issues and asked that they be addressed as a matter of urgency. We have also asked for confirmation that comprehensive guidance on all the above points as well as other key information is sent to all members of staff - and is consistent across all organisations in Wales. For medical staff, this must include GP contractors, all part-time and locum doctors, and medical students on clinical placement.

It is at times like this that everyone has to pull together, to ensure things run as smoothly as possible - but that will only happen when essential and often basic information is communicated in a timely, effective and consistent manner to those on the frontline - so that there is no confusion or time wasted over what exactly are the procedures to be followed. This will help NHS staff in Wales who do an outstanding job day to day, and pull out the stops further at times like this, to best protect themselves and so better serve the people of Wales.

Aiming for some perspective on swine flu

I thought it about time that I addressed the issue of swine flu here, having perhaps unintentionally avoided doing so, so far!

It is understandable that people will be worried when they hear about the potential number of fatalities that may arise due to the pandemic. However, it should be remembered that these are worst case scenarios, to enable government to plan.

I would urge everyone to follow the recommended advice and telephone their doctor or NHS Direct, rather than physically going to the surgery, if they have symptoms and are concerned.

In most cases, it will be a mild illness and the vast majority of people will recover quickly by taking paracetamol or ibuprofen, and drinking plenty of fluids. Anyone who is not recovering quickly or who is in a more vulnerable group, for example young children, pregnant women, or those with underlying health conditions, should get extra advice as a small number will need more intensive treatment.

The message we need to get across is it's a pandemic flu - this is new, we haven't seen this before and yes, most of us will probably catch it.

It is important to remember that every year there are deaths from complications of seasonal flu; this is unfortunately inevitable with any strain of influenza. But following the recommended advice should minimise the risk.

Simple but effective hygiene measures such as frequent hand-washing can also help. Cover your mouth with a tissue when you cough or sneeze, then put the tissue into a bin and remember the phrase which is fast becoming a mantra amongst healthcare professionals – “catch it, bin it, kill it!”

The latest information from the Welsh Assembly Government on swine flu can be found here.

Reminder about GMC Licensing campaign

I thought it important to bring to members’ attention the launch of the next phase of the GMC’s licensing campaign, called ‘Licensing: it’s time to decide’.

The GMC’s been asking registered doctors to confirm whether they wish to hold registration with a licence or registration without a licence when the scheme begins on 16th November 2009.

Having spoken to people in the GMC in Wales, apparently more than half the doctors on the medical register have now confirmed what they would like their status to be from November. So the focus of the next phase of the campaign is on those who’ve not yet made their licensing decision. A letter going out to these doctors over the next few weeks will ask them to confirm their choice before Friday 14th August, so time is fast running out.

There is also a new website called Licensing help, which you might find useful to take a look at. It features cases studies of doctors in different professional situations, as well as support from senior figures within the medical profession, who’ve already made their licensing decisions.

I filled in and sent off my reply indicating my decision after the first letter I received and I have to say it was a painless process but will be a more difficult decision for some, than for others. However, it is a decision we all have to make.

Health care professionals prove their worth as Swine Flu takes hold

The current outbreak of Swine Flu in Mexico is now spreading to many other countries including the UK. This is a concern for everyone, including here in Wales. However, we have to put this in perspective and rest assured that all necessary contingency plans, procedures and responses are in place to meet any escalation of the current situation. I have been observing the current preparations and it is impressive to see colleagues in GPC Wales and GPs across Wales rising to the challenge that this infection may cause. It is undoubtedly primary care that will be on the front line of reassuring, investigating and treating any and all cases that could arise in Wales, together with our public health colleagues. It is at times of such acute need that our health services perform to their best and will I am sure, as they are now, bring out the best in health professional joint working from doctors, nurses, pharmacists, paramedics and the ambulance service, social care services and a whole range of others, too numerous to mention here.

Strong leadership is also essential at times like this and the Welsh Assembly Government is demonstrating its role here. I have been enormously impressed by the timely and clear information being provided to the public and the profession in a context of reassurance, which I think gives confidence to all. The Chief Medical Officer, Dr Tony Jewell, has been at the forefront of these messages and it reminded me of how important the role of the Chief Medical Officer is in leading on such matters, which cross health boundaries into transport, education, entertainment and so on. The role of the Chief Medical Officer is crucial at times like this and shows unequivocally why Wales' top doctor should be sitting always at the top table of government.

Notifying members of the GMC’s new campaign “Licensing: It’s time to decide”

We want to make our members aware of the GMC’s new campaign “Licensing: It’s time to decide”. This is being introduced this autumn.

The GMC will be writing to all registered doctors over the course of the next few weeks, asking them to decide whether or not they want a licence to practise

After licensing is introduced, doctors wishing to undertake any form of medical practice for which the UK law currently requires GMC registration - such as writing prescriptions, and signing death and cremation certificates - will need to be both registered AND, hold a licence to practise.

More information about this is available on the GMC website - www.gmc-uk.org

Big Brother is watching – to help protect NHS staff

I know our members will welcome this announcement about a pilot CCTV scheme to deal with violence against NHS staff. Anything that can act as a deterrent is a good thing.

We have reiterated time and again how violence and aggression aimed at doctors and other health workers, just trying to do their job, ie. care for people, should be treated in such an appalling way. This is a growing problem which will not go away overnight. Our members should not have to live in daily fear of being attacked.

As some trusts already have CCTV cameras, why has the WAG not used this as a basis for the pilot, so that we would now be in a position to roll them out to all A&E departments in Wales?

And this is about more than just CCTV.

The BMA, giving evidence to the Audit Committee recently highlighted the following action areas;

• 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 lack of relevant information.

• Ownership and Responsibility for staff Safety - ensure that a senior staff member is given the responsibility for staff safety and monitored on that responsibility.

• Training and Communication - ensure that all staff are fully trained, 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 - ensure that patients and healthcare users know that they are not outside of the law while in contact with healthcare professionals, and that those offenders will be brought to justice.

• Police Liaison - to work in partnership to develop a common understanding of how attackers are dealt with.

This focus on CCTV cameras also shifts the emphasis on to NHS staff in hospitals, when violence is a particular problem for lone workers, ie. GPs and health visitors. Measures need to be taken to enusre their protection too.

Wales lags behind when it comes to stroke services

The Royal College of Physicians’ latest report into stroke care services makes for disappointing reading for Wales. There seem to be big geographical differences here, which don’t seem to be occurring in England and Northern Ireland. Has the so-called postcode lottery, seen in drugs and treatment for various forms of cancers, now spread to stroke services? Where you live, should have no bearing on the quality of stroke care you receive.

The report does highlight some areas that have improved, but as is so often the case, there is still plenty more to be achieved, to get Wales just on a par with other UK nations.

Some time ago, BMA Cymru Wales drew attention to the plight of stroke services and patients. In fact, we held a seminar on the issue, inviting Assembly Members to find out more about our concerns. I have to say, rather disappointingly, it was poorly attended by AMs.

No doubt many people reading this blog, will have seen the current TV advert, pointing out the need to act quickly when someone suffers a stroke. That’s to be commended, but we also need to make sure that once a patient reaches hospital, they are able to access the right services. Doctors know only too well how prompt action and the correct treatment can help with rehabilitation and long term damage. That’s why patients should be seen in stroke units up on their arrival at hospital.

Getting tough on violence in the NHS

Myself and a GP member of BMA Cymru Wales gave evidence to the Assembly Audit Committee yesterday, on the back of the Auditor General’s latest report into violence and aggression against NHS staff. The committee’s holding an inquiry into the report findings, because the Auditor General has found that violence is still a big issue for NHS workers.

That’s despite the fact that the Auditor General first looked into this four years ago and uncovered serious concerns back then.

It would be unfair of me to say that the WAG hasn’t made any progress on this in that time, as some improvements have been made (for instance, the launch of the training passport scheme in 2005) but I’m afraid there is still along way to go. And what is worrying for doctors, is that the emphasis on tackling violence seems to be focussed on hospitals, when in actual fact, a big area of concern identified in the report is NHS employees working alone, such as GPs and their support staff. More investment needs to be made here with the introduction of safety measures such as panic buttons and CCTV being installed.

This inquiry is very timely, as it’s now, during the on-going NHS reorganisation that systems like the Primary Care Support Service could be given more scope for development, to help in areas like violence and aggression against doctors.

I generally got the impression yesterday that AMs sitting on the Audit Committee are extremely concerned about the issue and there is a strong will to change things. I just hope that happens sooner rather than later and that ways of tackling this growing problem feature heavily in the Health Minister’s NHS reorganisation plans.

Ways for BMA members to broaden their horizons

This post will hopefully be of interest to most of our members, but it may be of particular interest to junior doctors, who may find it a bit easier at the start of their careers and whilst still relatively ‘young’ (not that I want to in any way be ageist here!) to head off to another country. I just want to highlight some new guidance issued by the BMA about doctors working in developing countries.

’Broadening your horizons: a guide to taking time out and work and train in developing countries’ outlines national policies, as well as examples of best practice. It’s aimed at both doctors and those in medical education and employment. It supports doctors at all stages of their careers to take time to work in developing countries and make it a valuable part of their NHS careers.

The guidance is available on the BMA website at http://www.bma.org.uk/careers/working_abroad/broadeningyourhorizons.jsp

2009 resolution to the WAG “Don’t leave doctors out in the cold this New Year”

As Chair of Welsh Council, I, like Richard would like to wish everyone all the best for the New Year. I'd also like to elaborate on Richard's comments about the challenging times facing doctors in the Welsh NHS, in 2009.

As we face another reorganisation of the NHS we could well ask ourselves "what is different about this one, from the numerous ones we have faced in the past?" This is a good and important question.

I think this one is different because of the underlying change of direction. That is, to dismantle the market place, the purchaser-provider split, with a return to a strategic planning of services. Also, the stated Ministerial aim to put doctors and other healthcare professionals back into the centre of decision making in the NHS and the services for patients, is to be welcomed.

We need to now be considering how best to be involved in the process of planning patient services in this new system. I know many of us will have doubts and bad past experiences. We have all had those. But I think we have a good opportunity now to get back to being influential, to be listened to and helping to change patient services, instead of having changes imposed on us, by those often furthest away from actual patient care.

If we don't get involved now, I think we will miss the chance that may not occur again for another 5 to 10 years. That will be damaging to patients and the care they receive.

But that said, as we doctors reflect on how best to involve ourselves in a way that best benefits our patients in the new Welsh NHS proposals, we would urge the Welsh Assembly Government and those who manage health services in Wales to make a New Year's resolution...don't let the commitment to a greater involvement of doctors and other health professionals be a passing phase, or one of those New Year's resolutions that start with good intentions but fade quickly as the New Year moves on. The medical profession in Wales is eager to rise to the challenge of making these new reforms work for the people of Wales - don't lose our confidence and trust by reneging on that Resolution and side-stepping doctors. This is a pivotal point for the NHS in Wales. Don't risk throwing away the seasonal goodwill of the profession in Wales.

Andrew Dearden,

Chair of BMA's Welsh Council

Dedication of doctors in Wales shines through

On the Friday before Christmas, one of my relatives unfortunately had a fall and fractured a wrist. I had to accompany my relative to our local Accident and Emergency Department, at a well-known Trust in Wales. I have to say that the whole experience - while not one I doubt anyone would particularly choose - couldn't really have gone much better.

After a reasonable wait in the A&E department, with a computer system that easily found my relative’s details, we were quickly ushered into the treatment area. From the initial examination and assessment by an able, capable and professional young Casualty doctor, through to the x-ray department and the high-tech digital x-ray facilities, to the Treatment Room and reduction of the fracture through to recovery and an overnight stay on the Ward - the whole experience demonstrated yet again the absolute dedication and professionalism of doctors in Wales and other healthcare professionals.

Irrespective of political and managerial reform of health services in Wales, or elsewhere, the one abiding and unchanging aspect of health is the need of the individual and the skill and the dedication of the doctors able to deliver it.