Victory for common sense

Recently I’d heard of some cases where BMA members (particularly junior doctors) were being told they couldn’t take time off during working hours to carry out trade union duties. This completely contravenes the partnership working arrangements we fought to get in place, in order for our members to be able to conduct BMA work.

So, having had this brought to my attention, I have written a letter to Paul Williams, Chief Exec of NHS Wales to remind of our position as a trade union and the rights that go along with that status.

I am delighted to be able to tell you, that I have had following response from my letter…

Dear Colleagues

BMA MEMBERS – TRADE UNION DUTIES

Richard Lewis, Welsh Secretary for BMA Cymru Wales, has sent Paul Williams the attached letter of 12 May 2009.

I confirm that the Welsh Assembly Government expects all NHS employers in Wales to allow representatives of recognised staff organisations such as those of the BMA to be granted reasonable time off during working hours to undertake their trade union duties. This is in accordance with both the partnership working arrangements that have been agreed and established within Wales, and with the relevant legislation.

I understand the particular problems the BMA are concerned about relate to a reluctance of some Trusts to provide the relevant time off to junior doctors undertaking trade union duties.

I should be grateful if you will ensure - and confirm with the BMA locally - that this is not the case in your Trust, or that you take agreed steps to overcome any such difficulties.

Yours sincerely

Sheelagh Lloyd Jones
HR Director, NHS Wales

So, please continue to let myself or any of the staff at BMA Cymru Wales know if you are having difficulties with your employers giving you time off work, for BMA activities. It is not a situation you have to put up with!

Getting behind meeting targets in the NHS

The latest NHS Wales Diagnostic and Therapy Services waiting times should be welcomed as they show that, as of the 31st March 2009, no patients are waiting more than eight weeks for specified diagnostic services and that no one is waiting more than fourteen weeks for specified therapy services. This means that the WAG has met the targets set for these services. I just hope that these figures are replicated in the coming months.

I would just stress a note of caution about these stats too. While they are undoubtedly good for this group of patients, it is important that in blind focusing on targets (whatever they maybe) we do not adversely affect the services to others who may have far greater clinical priorities.

Increasing the involvement of doctors in prioritising the needs of patients will be essential in ensuring the NHS in Wales delivers optimal health services for the people of Wales within finite resources.

To wear a white coat, or not to wear white coat? That is the question…

OK, so I’ll make this clear from the start, I do NOT have a problem with the Welsh Assembly Government’s recent announcement to introduce colour-coded uniforms for nurses in NHS Wales. It will undoubtedly help patients identify who’s who. But more importantly here, there needs to be adequate laundry services and sufficient change of clothing to assist in reducing cross infection. Is this guaranteed? Given the fact that in this article the Assembly only “hopes to have laundries in hospitals”, let’s hope it’s more than just an aspiration.

On another point – the same article has the Chief Nursing Officer Rosemary Kennedy quoted as saying “We do have doctors floating around with white coats flapping around behind them. We have got very lax.”

This is disparaging of the many doctors in NHS Wales who are hard working, often for many excessive and continuous hours to plug gaps in rotas. They are far from “floating around”. Little wonder then that Wales is not top of junior doctors destinations with comments like this.

I don’t really think doctors and white coats “flapping” or otherwise is the real issue here when it comes to hygiene. They are no more of an infection risk than any other type of hospital clothing. What matters most is having comprehensive laundry facilities, with fresh clothing frequently available. We can of course hope for this!

This highlights a bigger issue about NHS uniform policy and it’s something that the BMA’s Welsh Medical Student’s Committee (WMSC) has been trying to get clear guidance and a straight answer on for some time now.

18 months ago the WMSC wrote to the Health Minister asking for clarification regarding hospital hygiene and “white coat” protocols and the committee, despite repeated attempts, is no closer to getting an answer on this, with the policy seemingly decided on an individual trust basis. So, our more junior members, when on rotation, are going to different hospitals, where in some cases, they can wear white coats and in others, are told it’s not acceptable to wear them. All this confusion still remains, despite the fact that an All Wales Uniform Working Group was set up by the WAG to look into white coats protocol amongst other things, more than a year ago. Not much “flapping” going on there then!

Consultation needed on organ donation debate

The Health Minister's announcement, to look into changing the law surrounding organ donation in Wales, in particular, the consideration to introducing an opt-out system, is a good move.

For many years now we've backed the idea of a “soft” opt-out system. There is little doubt that such a system would produce a far higher potential donor rate than at present, which is far too low at 22%. Experience of other European countries that have already introduced an opt-out scheme have proven this to be the case. More than 500 people in Wales are still waiting for transplants and one person dies each day in the UK, waiting.

A “soft” opt-out system involves people having the opportunity at EVERY stage, to make it known if they do not want to donate their organs after death. Consent to donation would only be presumed, if individuals expressed no objection. Families would also be consulted and donation would not proceed if relatives would be seriously distressed. Doctors would consult with patients’ and their loved ones, every step of the way.

In previous public opinion surveys, the vast majority of people say they would be willing to donate their organs. Unfortunately, this does not translate into people who actually sign the register. This is where the crux of the problem lies. People want to be donors, but for whatever reason, they just don't get round to signing the register. Of course, that would not be an issue with an opt-out system and that is how a change to legislation, could make all the difference to anyone left waiting on the organ donor register.

By making improvements to the transplant infrastructure as well, such as more training, increasing the availability of transplant co-ordinators, reviewing the health service’s capacity to cope and ensuring sufficient availability of intensive and critical care beds, then Wales would really be able to say it had made a significant contribution to saving the lives of those on transplant lists.

Another clear message from this consultation is that far more needs to be done to ensure the public is fully informed about the current system and fully involved in any future changes and decisions.

What do you think about introducing a "soft" opt-out system?

Be interesting to know what doctors' views are on this...

Concern over readiness for EWTD in the Welsh NHS deepens

My concern about the effects from the implementation of the EWTD (European Working Time Directive) weren’t just confirmed at BMA Cymru Wales’ recent Policy day on the matter – they grew a whole lot deeper.

The Directive puts a limit on the working week of 48 hours for all employed doctors, including junior doctors, and it must be implemented by Trusts in full, no later than 1st August this year. Junior doctors were excluded from the original legislation because of the nature of their training, and the limit of 48 hours was to be phased in.

The deadline is fast approaching and despite the fact Trusts have had (literally) years to prepare for it, to say that we are still some way from being ready to move to a reduced working week, and thus ready to ensure essential protection for doctors and patients, is a massive understatement. This was highlighted by the Wales Audit Office just a few weeks ago.

A number of key messages came out of the Policy day, including drastic junior shortages, compounded by insufficient numbers of consultants to fulfill requirements of services to patients whilst at the same time trying to provide the dedicated and comprehensive training and support juniors need.

Also, members, with frontline-delivery experience, suggested a number of solutions in order for Wales to prepare and to cope with the implementation of EWTD. BMA Cymru, as the voice of doctors in Wales, will be taking these up with the Health Minister and with Welsh NHS Trusts in the next few weeks and as we approach the August deadline.

But with the situation already dire and morale amongst junior doctors at an all time low, without central support and adequate preparation from Trusts there is a significant threat to the current standard of medical training, to the delivery of healthcare provision, and to the quality of patient care as a result.