In any discussion on the differences between the health systems in the four devolved nations, it is likely that you will hear the statement that Wales has placed a much greater emphasis on public health than elsewhere in the UK.
This is something the NHS in Wales is rightly proud of – it is not always easy to take a long term view in the face of immediate and unrelenting pressures on services.
The Welsh Government’s Public Health (Wales) Bill, and last week’s additional draft Bill to introduce a minimum unit price for alcohol, both have potential to add even more weight to our claim of being a nation that is serious about public health.
The principles of the Bill are currently undergoing scrutiny by the Assembly’s Health Committee, and the Welsh NHS Confederation has submitted evidence on behalf our members, the seven Local Health Boards and three NHS Trusts in Wales. In it, we support the measures put forward by the Welsh Government but we also highlight areas where we think the Bill could go further.
The headline issue which has dominated much of the debate so far is the ban on e-cigarettes in enclosed public places. While some have argued that e-cigarettes can be used as an aid to quit smoking, we believe that a consistent approach is needed to bring e-cigarettes in line with current legislation on smoking in public places.
Continuing to allow the use of e-cigarettes in enclosed public places has the potential to undermine some of the gains that have been made through the smoking ban. It can be hard, particularly from a distance, to differentiate between those smoking tobacco and those using e-cigarettes, which makes enforcement of the ban difficult.
Current research on this issue is limited, but rather than helping people to quit, e-cigarettes could also act as a gateway to conventional tobacco by appealing to young people. They can give the impression that they are a safe alternative, even though they still include addictive and high levels of nicotine.
In some cases, e-cigarettes might have eight times as much nicotine as a traditional cigarette. But because they are not so strictly regulated, the nicotine dose is not always monitored or clearly displayed on the packaging.
And while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.
While the debate on e-cigarettes will no doubt continue, the scope of the Bill goes much wider, and in some cases, we believe some of the other measures it includes could be strengthened.
One such measure is the proposal to create a mandatory licensing scheme for businesses carrying out ‘special procedures’, namely acupuncture, body piercing, electrolysis and tattooing.
This is something that we strongly support, as the consequences of leaving this industry unregulated have an impact not just on health, but on safeguarding and child protection.
Our evidence calls for this measure to be widened to include procedures such as body modification, injection of any liquid into the body (e.g. botox), colonics, dental jewellery, chemical peels, and laser treatments such as used for tattoo removal.
As things stand, the public has absolutely no idea when they go to premises offering these procedures, whether they are safe, whether they are clean, or whether the person is competent. This is a serious concern. There is the potential risk, whenever there is anything sharp that is reused, that it may not be sterilised properly and infection can be transmitted.
We also support the Bill’s proposal to outlaw intimate piercing of anyone under 16. A recent look-back exercise in Gwent found that six people under 16 had intimate piercings, with girls as young as 13 undergoing nipple piercing.
We feel this is an area where we have lagged behind in safeguarding young people, and the Bill provides an important opportunity to address it.
An important addition to the Bill was the Welsh Government’s announcement last week of its intention to introduce on a minimum 50p unit price for alcohol. There is a strong evidence base for the link between alcohol affordability and levels of harm. This prudent initiative has received support across the board, and we are hopeful that it will be an important step in reducing the harmful effects that alcohol has on our health service and society as a whole.
One area that the Bill does not specifically address is the rising level of obesity, and further concerted action is needed across all sectors to try and reverse this.
We acknowledge that this is an issue that may require a UK-wide approach, particularly where proposed legislation concerns the food and drink industry. The idea of a “sugar tax” on some fizzy drinks and unhealthy snacks has been floated. However, many of the levers to change the way food processing and labelling is governed are not within the powers of the devolved nations, but instead lie with the UK Government or Europe.
Something that is within our gift here in Wales is to strengthen the Bill’s measures on the regulation of food standards in settings such as hospitals, pre-schools and care homes. Maintaining food standards, particularly in health settings, has huge potential to influence the public’s perception of what foods are considered acceptable and healthy. Mandated criteria for the provision of healthier items in hospital restaurants would help hospitals in Wales to fulfil their responsibility for improving the health of the population they serve.
As the Public Health Bill continues its passage through the Assembly, the Welsh NHS Confederation will continue to stress that public health must not be seen as a standalone issue to be addressed solely by the NHS.
It is the responsibility of a wide range of sectors which need to work together and develop a ‘health in all policies’ approach to tackle the issues that we face.
This will require a more sophisticated view of health and wellbeing, looking widely at economic opportunities, such as availability of jobs, education, and strategies to tackle poverty; and the social environment, such as the quality of neighbourhoods and housing, and sport and leisure opportunities.
It is vital that we do this to reduce levels of ill health, and to reduce our increasing and unsustainable reliance on health services. The Public Health Bill is a welcome, positive step, but we would like to see a clear vision of what it intends to achieve and how success will be measured.
At the same time, we cannot be complacent about what legislation alone can achieve. We must continue our determination, across all sectors, to improve the health and wellbeing of the people of Wales through all the means available to us.