Dewis Doeth - Choose Well

On Friday the Daily Post ran a report about the A&E at Ysbyty Gwynedd being overloaded one night.

We've all watched Casualty and know it happens sometimes.

In the first place I think it's important to recognise the A&E at Ysbyty Gwynedd is showing its age and is in urgent need of modernisation. And plans to do this are well on the cards: Emergency Department - Refurbishment and New Build (pdf)

Not sure at what stage this vital work is in terms of approval, but it seems Betsi Cadwaladr has submitted the £8.5 million scheme to the Welsh Government for approval.

See Wales Online - £8.5m casualty upgrade planned at Ysbyty Gwynedd

Lets hope these vital works can start soon.

Anyway back to the queuing problem, the Daily Post report quotes Health Board spokeswoman as saying "It is also important to remember that by Choosing Well for the right treatment, patients can help us free up emergency medical care for those facing life threatening illnesses or injuries."

Choosing Well is about all of us taking some responsibility for how we look after ourselves, and if we feel unwell or have an accident that we make the right choice and just don't panic and rush off to A&E :

The Choose Well Website is there to help you make the right decision, their is even an app you can download to your mobile phone.

See also: Betsi Cadwaladr Website

NHS in Wales

Aneurin Bevan

Yesterday, Judith Phillips in the Daily Post was all gloom and doom about the NHS in Wales. She does say and I quote "but it seems we have now reached a crisis point where public confidence in those running the NHS in North Wales is at an all time low."

What utter bullshit - yes complete and utter drivel....

Now what do you mean I hear you ask - well lets start with her conclusion and I quote again "but throwing the responsibility for the level of care given by community hospitals onto families and county council social services departments, is in my opinion going to open up yet another can of worms."

Which does rather show she has no clue what she is talking about, that she does not realise that the family and the local council was an integral part of our care system as envisaged when the NHS was established in the very first place.

We should be proud of the NHS, of what it has achieved, but we need also to recognise that in changing times what was the remedy of yesteryear may not be the best use of the 'limited' resources available to us now.

And in reaching those decision as to the future shape of the NHS within Wales they should be based on clear cut clinical opinion, made in the best interest of all of us. Not may I add the straw sample of a deluded correspondent of the Daily Post.

Take community hospitals....lets be honest they have had their day, they are not really the answer to our needs. Let me go further.....the moment someone comes a patient at a community hospital is in reality a sign of failure somewhere else.

We should be truly proud of the welfare system this country has, think....we are all living longer thanks to welfare, we have less infant deaths thanks to welfare.....and just on the simple fact there are more of us, will mean welfare costs will go up.

Which brings me to being old.

Think about....if put simply you have the countries GDP and from that you need to pay for children, adults and pensioners. Are we really in a society that as children demanded to be feed, then when working moaned that everyone else wanted to be fed and in our retirement demand that we are fed again?

Personal responsibility, the ability to plan and care for oneself - that is the aim we all should have. And the majority of us will live full and independent lives.

But sometime along the road we may need assistance, and sometimes we may need care, and sometimes we might even need acute care as we wait for death. Death is inevitable, but it need not be in pain.

We have plenty of care homes, the private sector in the most provide a very good service, and sometimes for some people whom cannot look after themselves that is the best place for them to be.

However what of those with acute needs - such as dementia or alzheimers, what they need is specialised palliative care in purpose built nursing homes. And that is one thing we lack, sufficient nursing homes to care for those who need specialised care, even if just means providing respite for the caring family.

Nursing homes built with the dignity of the patient in mind, with single rooms and trained staff, where someone comes to die because we cared and not because we pushed them aside.

So here in part is my prescription for the NHS:

• We need local doctor surgeries to be in modern buildings that offer a greater range of services to their patients.
• We need more district nurses.
• We need more paramedics.
• We need more pharmacists, and a consulting room in every pharmacy.
• We need more doctors
• We need more palliative care nurses

Now up to now I hope you will see my list is mostly more people not more buildings, if we get the prevention right we would need less buildings so to speak.

But if we need to decide as to priorities in brick and mortar then that would be the need for more acute care nursing homes, to complement and build on the excellent work done by charities such as Marie Curie.

Now I know it wont be popular, but let's be clear

....no beating about the bush...

......Community Hospitals are not the answer.

.........you know do try an keep up....

People understand need for change in Welsh NHS

As we are continually reminded by politicians...we are in a heap of trouble and it may get worse in 2013. So I suppose things have to change to make the most of the limited resources available, and as such the changes in the NHS need to be taken in that context. However, a recent survey showed that the public would be concerned if any changes affected the quality of care.

A survey by YouGov of more than 1,000 Welsh adults between 16 and 21 November 2012, commissioned by the Welsh NHS Confederation found:

• 65% of people named “lack of funding” as the biggest challenge facing the NHS in Wales, compared with 46% last year.
• Almost half (48%) are aware that the NHS needs to make changes to the way health services are organised to make best use of scarce financial resources.
• There is growing awareness of the challenges posed by caring for an elderly population (up to 53% from 43% last year), and also an unhealthy population (up to 41% from 34%).
• The Welsh public also appear to understand the need to make changes to improve standards of care. 22% named it as one of their top three reasons for why they think Health Boards in Wales are planning to change the way services are delivered. 32% of people were aware that the quality of NHS care varies from place to place and changes are needed to make all services of an equal standard, while 28% of people were aware that the standards of care provided on weekends is not as good as weekdays.
• The quality of care was given as the top answer for what people would prioritise when it comes to hospital care. 59% named it as one their three main considerations, while only 14% named travelling distance.
• Even though most people (59%) feel that their local hospital should be able to provide every type of health service for their local community, 79% of people said they would be prepared to travel further, for example by an extra hour, to see a specialist, while 45% said they would be prepared to travel further for higher quality care.
• Opinion is fairly evenly split on whether establishing specialist centres for certain types of services is a good idea, with 33% of people saying it would make services better, compared to 19% who thought it would make services worse. 24% people said it would make no difference.

See YouGov: Survey finds growing public awareness of why the NHS must change

Prof. Longley's NHS report raises important questions, we need serious answers.

I sadly see that welsh politicians are still playing silly games, with patient care, and the urgent need to reform the NHS in Wales. I say get a grip and start dealing with the important questions Prof Longley raises in his report.

And I'm not alone in thinking along these lines, below is a statement from NHS Wales Medical Directors:

We would like to go on record fully supporting the content of Prof. Marcus Longley’s report. As senior doctors, we recognise the evidence it contains, and are confident that it is a true and accurate account of the issues facing the NHS in Wales.

We work with these very serious challenges on a daily basis and it is vital that the report’s key messages are not ignored, and that urgent action is taken.

The NHS in Wales urgently needs reform, otherwise services will collapse and patients will suffer. This report offers the platform to launch those reforms.

The NHS in Wales is too important to be a political football. We all need to work together to develop a safer, more effective and sustainable NHS in Wales for the future.

Dr Bruce Ferguson, Medical Director, ABM University Health Board,
Dr Kamal Asaad, Medical Director, Cwm Taf Health Board,
Dr Simon Mahon, Medical Director, Hywel Dda Health Board,
Dr Mark Scriven, Medical Director, Betsi Cadwaladr University Health Board,
Dr Grant Robinson, Aneurin Bevan Health Board
Dr Brendan Lloyd, Medical Director Powys Teaching Health Board,
Prof. Peter Barrett-Lee, Medical Director, Velindre NHS Trust

Make your own mind up - to download Prof. Longley's report in pdf format: The Best Configuration of Hospital Services for Wales: A Review of the Evidence.

NHS in Wales - how can we improve the service?

Let's be clear, the NHS in Wales needs to be reformed, it's costing too much money and we cant afford it. This means having to take some difficult decisions like moving some specialist care to centers of excellence, and either reducing level of care at general hospitals or closing them altogether. One reason for this is the shortage of trained nurses and doctors. And this is not a problem for Wales alone, a similar path is been followed in London see: BBC News Four north-west London A&E departments face closure.

We all need to ask this fundamental question: How do we; having regard to the need to make substantial savings in the NHS budget, provide a modern service that meets the expectations of the public and those of the founding fathers, at a time when the call on the NHS is growing annually?

This should be the benchmark - will my actions make the NHS better, otherwise what's the point?

As Prof Longley says We now desperately need a serious public debate about these issues. Most of the NHS in Wales provides a good and robust service; but key bits are giving serious cause for concern. Choices are now required on what to do about this. To sit on our hands and ignore the evidence is to put at risk the quality of care for future patients.

Which brings me to 'Opposition unites behind no confidence motion in Lesley Griffiths' (BBC News)

As you may know a report published in May by Prof Longley said changes are needed to the NHS in Wales. Welsh Government ministers used this independent report as justification for changes they are implementing in NHS provision across Wales.

Even I could have told them that, the days of general hospitals are over, we can't afford them and they don't provide good quality for money. Of course closing local hospitals is never going to be an easy task, most politicians think that supporting closure of their local hospital would be political suicide.

As the old adage says 'Don't like the message shot the messenger' which is what it seems the opposition parties are doing, with their rather silly motion of no confidence, because they say the report by Prof  Longley wasn't as independent as claimed.

But what will it achieve, say if Leslie Griffiths AM, Health Minister did resign, what then?

To return to my benchmark question, would this make the NHS better? - the difficult question of the need to reform the NHS would still be there, other than some cheap political point scoring nothing would have been achieved.

I suppose there will be a debate on the motion of no confidence, of which there is little chance of it being passed. Are the opposition parties really telling me that instead of the Welsh Assembly debating important issues that affect us all, they want to waste time so they can score some cheap political points. Do they really think the welsh public are that stupid?

And what is Plaid Cymru doing, come on Leanne Woods get a grip!! - remember being seen to side with the Welsh Conservatives will do you, nor your party any favours (just ask the previous leader Ieuan Wyn Jones).

As for the Welsh Conservatives whom according to latest opinion polls are less popular than UKIP, are these the first salvos in Shadow Health Minister, Darren Millar AM bid to become the next Welsh Conservatives leader? - after all, even though I might disagree with what he says, he does seem to be the most effective Conservative AM of recent times.

NHS - we remember Aneurin Bevan

Listening to David Cameron yesterday, talking about the dismantling of the NHS as we know it, with a top to bottom reform (even though in their manifesto they said they would not) made me question whether the veneer has finally started to crack on that polished image the Conservatives have tried to portray.

Is the nasty ‘Tory’ party back, is it their way or the highway. What happened to constructive dialogue and the big society? - instead it seems we were told anybody that doesn’t agree with the ‘Leader’ needs to grow up - or what we ask, is he going to take his football home?

Luckily for us the Lansley NHS reforms are for England only, or are they – will the Welsh Conservatives follow the lead of their leader?

Anyhow let me remind you of the days when politicians were politicians with this extract from an essay by Aneurin Bevan about the NHS from 1952

"When I was engaged in formulating the main principles of the British Health Service, I had to give careful study to various proposals for financing it, and as this aspect of the scheme is a matter of anxious discussion in many other parts of the world, it may be useful if I set down the main considerations that guided my choice. In the first place, what was to be its financial relationship with national insurance; should the health service be on an insurance basis? I decided against this. It had always seemed to me that a personal contributory basis was peculiarly inappropriate to a national health service. There is, for example, the question of the qualifying period. That is to say, so many contributions for this benefit, and so many more for additional benefits, until enough contributions are eventually paid to qualify the contributor for the full range of benefits.In the case of health treatment this would give rise to endless anomalies, quite apart from the administrative jungle which would pe created. This is already the case in countries where people insure privately for operations as distinct from hospital or vice versa.

Whatever may be said for it in private insurance, it would be out of place in a national scheme. Imagine a patient lying in hospital after an operation and ruefully reflecting that if the operation had been delayed another month he would have qualified for the operation benefit. Limited benefits for limited contributions ignore the overriding consideration that the full range of health machinery must be there in any case, independent of the patient's right of free access to it. Where a patient claimed he could not afford treatment, an investigation would have to be made into his means, with all the personal humiliation and vexation involved. This scarcely provides the relaxed mental condition needed for a quick and full recovery. Of course there is always the right to refuse treatment to a person who cannot afford it. You can always 'pass by on the other side'. That may be sound economics. It could not be worse morals.

Some American friends tried hard to persuade me that one way out of the alleged dilemma of providing free health treatment for people able to afford to pay for it would be to 'fix an income limit below which treatment would be free while those above, must pay. This makes the worst of all worlds. It still involves proof, with disadvantages I have already described. In addition it is exposed to lying and cheating and all sorts of insidious nepotism.

And these are the least of its shortcomings. The really objectionable feature is the creation of a two-standard health service, one below and one above the salt. It is merely the old British Poor Law system over again. Even if the service given is the same in both categories there will always be the suspicion in the mind of the patient that it is not so, and this again is not a healthy mental state.

The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged."

The above extract and much more of his words can be found at:
Aneurin Bevan and the foundation of the NHS