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.

Stroke patients in Wales deserve better

Having come across this latest research into acute stroke care centres, it only serves to demonstrate just how much Wales continues to lag behind other countries, including England and Ireland and how vital it is that Wales not only starts playing catch up, but that it also is at least on a par with other countries.

The research highlights how having dedicated specialist stroke centres greatly improves the acute and long-term care of patients. Being treated in such centres can double a patient’s chances of surviving a stroke and not sustaining any long-term damage. In England, nearly all hospitals have these units, yet only half of Welsh hospitals do.

The NHS reorganisation provides a golden opportunity for the new Local Health Boards to each establish specialised stroke units, not necessarily for every hospital to have a unit, but for patients to be within a reasonable travelling distance of a facility. Someone getting the best possible stroke treatment shouldn’t depend upon where they live, as seems to be the case. A patient suffering a stroke in Cardiff, close to the UHW is undoubtedly in a better position than someone in a more rural area.

Funding is a big factor in the gap between stroke services in Wales and other countries. Just taking the rest of the UK as an example, England has earmarked £105 million and Northern Ireland has set aside £14 million over three years, with a further £9m available. That compares to the Welsh Assembly Government’s £2.5 million per year for three years. And England and Northern Ireland were already ahead of Wales with regard to the quality of stroke services.

The Stroke Services Improvement Programme is visiting all parts of Wales over the summer, hopefully providing an overview of service gaps and giving indications as to what level of funding is required.

The Health, Wellbeing and Local Government Comittee is currently carrying out an inquiry into stroke services. Two of the committee’s main Terms of Reference include looking at the availability of specialist stroke units in hospitals across Wales and geographical variation in these services and the resources devoted to stroke services in Wales. So hopefully, recommdendations will be made and more importantly acted upon, which see stroke patients in Wales getting AT LEAST the same level of treatment as elsewhere in the UK. And any recommendations made in this inquiry need to be acted upon sooner, rather than later.

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.

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.