ARM – day four – rounding off with occupational health, tobacco and alcohol debates

To kick off the last session of the BMA’s 2009 ARM conference, members looked at the topic of occupational health, something which has been a pertinent issue at BMA Cymru Wales recently. We’ve been seeking assurances that the future of the Primary Care Support Service (PCSS), which is the ONLY occupational health service for doctors in primary care, will be secured during the NHS reorganisation agenda.

Next – on to motions on the environment, calling on the BMA to do more to highlight the global health risks associated with climate change and to reduce our own carbon footprint. We then turned to the important public health issues of nutrition, exercise and obesity, an area in which Wales faces considerable challenges if we are to address them, particularly childhood obesity. Motions calling for more local recreational facilities (swimming pools, cycle routes etc) remind me that when I get back I must find out how Dr Dai Lloyd AM’s proposed Measure on playing fields is getting on.

The HPV vaccine sparked a valuable and lively debate with conference deciding that the roll-out of the vaccine should be extended to boys not just girls, and that it has been a missed opportunity to vaccinate against other diseases such as genital warts.

Also a subject with high prevalence rates in Wales: drugs and addiction. The topics covered by this set of motions call for minimum unit pricing for alcohol; clearer labelling; a ban on alcohol advertising in the media and the redirection of revenue into prevention and rehabilitation programmes. These motions passed UNANIMOUSLY.

Tobacco also generated a good discussion with motions proposed for all forms of tobacco advertising to be banned, including at the point of sale and another calling for cigarette vending machines to be restricted.

After four days of rigorous and impassioned debate, conference draws to a close and its time to return to Cardiff. The ARM has set BMA policy and determined many of the issues that we will be working on for the next twelve months.

For anyone who wants to see a full webcast and results of the motions debated this week click here.

ARM – focus on student finance/debt

And so to yesterday afternoon’s session of the ARM.

We heard the reports from chairs of the following branch of practice committees: general practice; private practice; staff and associate specialists; medical students and junior doctors.

A number of issues within those professions were debated. Conference was treated to a notably lively and impassioned debate on student fees. This is something the Welsh Medical Student Committee (WMSC) has been working on in recent months following the Assembly Education Minister’s proposals to re-focus higher education in Wales.

I know that the Chair of WMSC, Elliott King, has spent many hours considering the implications of the proposals for medical students in Wales and along with the Committee has crafted BMA Cymru Wales’ response to this, at the same time as sitting his own final year exams. I’m looking forward to welcoming Elliott back as Dr King next term given his recent finals success. Congratulations to Elliott and all those who’ve passed their exams.

Conference heard from students who will be graduating with a crippling debt of more than £30,000.

The important area of medical education and training for Junior Doctors also delivered a lively debate. The mention of EWTD, working patterns, rota gaps and student/teacher ratios were met by jeers from fellow Juniors and other delegates. Again the issue of free accommodation for Junior Doctors was discussed. I wonder just how long it will take other nations to follow Wales lead and recognise the value of this important policy.

We’ve had the recommendations, now let’s see action on violence and aggression against NHS workers

Away from the ARM briefly and I’m really pleased to come across this story .

I, along with a GP member of the BMA in Wales gave evidence to the Assembly Audit Committee earlier this year, stressing the very points the Audit Committee has made; namely that not enough is being done to tackle this very real, worrying and growing problem for frontline NHS staff. I do fully acknowledge that some progress has been made in recent years, but not nearly enough, particularly when it comes to prosecuting anyone who is verbally or physically abusive to healthcare professionals - this needs to be properly addressed by the new LHBs in Wales - such that they set a clear line in the sand at their inception.

I would be more than happy, as the committee recommends, to work with Welsh Assembly Government to consider options for tough new legislation; and develop further some of the following action areas highlighted:

• A register of violent patients: allowing doctors, nurses and other healthcare personnel to 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 staff are encouraged to report incidents of violence and aggression and that senior staff take responsibility for staff safety and comprehensively monitor it.

• Training and Communication - ensure that all staff are fully trained, are aware of the mechanisms to report physical or verbal abuse; and clear guidelines are promoted to raise awareness with staff - and deter violent and aggressive acts by patients

• Staff Support - ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident, including through any legal processes that may be pursued.

And if any of our members reading this have been a victim of violence and aggression at work, please let us know.

ARM - day three - medical ethics

So, to the motions on Medical Ethics which saw some of the liveliest debates in ARM history - not surprising I guess, given the content of the motions and the fact that they apply to all branches of the profession across the UK.

Opening this section was Wales’ own Dr Tony Calland, Chair of the BMA Ethics Committee, who outlined the issues that the Committee continues to work on: top-up payments; pandemic flu; presumed consent; compulsory vaccinations; assisted dying and Clause 152 of the Coroners and Justice Bill, which relates to the sharing of patient records (after a successful campaign the BMA recently managed to get this clause removed from the Bill).

On to the motions:

The first relates to spiritual care in the NHS – it follows this story. The motions which passed recognised that the NHS is committed to providing spiritual care to patients and noted guidance from the GMC on the inappropriate discussion of faith issues. Faith is obviously a sensitive and highly personal subject which would explain the heated debate which followed. While recognizing the importance of faith as a part of holistic health care, conference fell short of supporting doctors initiating the issue with patients.

Next up, a motion objecting to the proposed use of TV advertising for abortion services. The motion, proposed by the Yorkshire Regional Council, stated that the adverts will give the wrong message to young women and promotes sex as a values-free activity with a quick medical fix. For many different reasons, the motion fell and in my view, rightly so. It is important that patients receive as much information as possible, particularly women in a situation where they have to consider the complex and distressing decision of whether to continue with a pregnancy or not. As doctors, we have a duty to ensure that our patients have as much information as possible while exercising their right to choose.

Finally in the Medical Ethics section: assisted dying. This motion called for those people accompanying the patient in an assisted death, but not actively participating, be exempt from prosecution; and for patients who are terminally ill but who have full mental capacity to be allowed to make a choice on assisted death. Baroness Ilora Finlay spoke eloquently against this motion drawing on her particular expertise; and indeed both parts of the motion fell – although it was an extremely close vote with very convincing accounts from both sides.

So far it’s been a highly interesting, topical and emotive session.

More to follow...

Put children first in the fight to reduce health inequalities

Another motion up for debate yesterday at the ARM focused on safeguarding children and their futures.

Delegates are calling on the Welsh Assembly Government to put youngsters at the heart of every one of its department’s priorities, for the next two decades, to give ALL children the best start in life.

One way of dong this could be to increase the number of school nurses in Wales and for these nurses to also take responsibility for public health in schools.

With the measles outbreak which is sweeping through Wales at the moment, there has never been a better time for the WAG to honour its promise, laid down in the One Wales manifesto, to provide a minimum of one family nurse per secondary school by the end of the Assembly term.

I think School Public Health Nurses could have played an integral part in helping to prevent the current measles epidemic from spreading as much as it has by providing advice and guidance to parents.

We need to ensure ALL children are given the best possible start in life and where they go to school can have a big impact on this. That’s why, in the most deprived areas of Wales, we need to transform schools in to safe havens for those youngsters from disadvantaged backgrounds.

Very pleasant walk around the Albert dock by the way, shame I didn’t have my camera with me to take a few scenic shots to share with you all on here!