Kate Cubbage calls on the next government to prioritise challenging the link between poverty and poor health outcomes.
The run up to the 2016 election for the National Assembly for Wales is an opportunity, both to reflect on the progress that has been made in public health and the Welsh NHS over the last 5 years, and to identify how we can do things better in the future.
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The current focus on empowering individuals to be partners in their own care, with an increasing sense of personal responsibility for maximising their own health outcomes, is to be applauded.
However, it remains important for government policy to prioritise challenging the link between poverty and poor health outcomes, addressing head-on the socio-economic causes of ill health. As part of an overarching strategy, evidence-based policies to tackle behaviours that are strongly linked to health inequalities must be implemented. For Wales, this is particularly important in relation to alcohol consumption, smoking and obesity.
We know that alcohol misuse is a growing problem in Wales. Far more can and should be done to encourage responsible retailing, labelling and marketing and to provide appropriate and timely treatment for those in crisis.
Smoking in Wales remains the leading single cause of serious illness and avoidable early death. More can be done to increase the number of smoke-free open spaces for people to enjoy.
As well as smoke-free open spaces, it is important that there are enough outdoor recreational facilities to support a more active nation. Obesity and physical inactivity are associated with a wide range of serious life threatening chronic diseases.
As well as developing sufficient and convenient opportunities for sport and exercise for all, far more needs to be done to curb the promotion and availability of unhealthy foods, especially in close proximity to schools.
Despite the potential for preventative policies to improve the nation’s health, this progress will inevitably take time. Demand for NHS services is at an all-time high and it is essential that a preventative focus does not detract from ensuring that the NHS in Wales is equipped to deal appropriately with the needs of today’s patients.
In addition to empowering people to make positive steps in their own health journeys it is essential to address the sustainability of the NHS in Wales. Today’s doctors have multiple roles: they are clinicians, leaders, teachers, managers and researchers. High-quality patient care goes hand in hand with a highly motivated and committed medical workforce. However, many members of BMA Cymru Wales report feeling increasingly de-professionalised, repeatedly devalued and worryingly isolated.
For progress to be made, workforce planning needs to be more dynamic, robust and pro-active, taking into account the medical training requirements, the changing service demands and workforce composition. Currently, there is too much short-term thinking and not enough support for existing professionals to thrive.
Respecting professional judgement is an essential component of running an effective and efficient service. To ensure the quality and safety of patient care more needs to be done to support and protect frontline services so that clinical quality and patient safety, rather than targets, are paramount across the NHS.
A survey of BMA Cymru Wales’ members suggested that there is a need to recognise that financial or organisational performance targets can create incentives that conflict with clinical judgement. The target should never come ahead of the patient, but this is not always the case. Reform of referral to treatment time targets in favour of focussing on prioritising clinical need would increase both the efficiency of the service and patient experience. Focussing on measuring outcome performance rather than on process performance would be a step forward.
Doctors care about their patients. A key part of that is having the confidence to raise concerns on their behalf. To make this a reality we need a culture of openness within the NHS, not one where raising concerns can leave doctors feeling harassed or marginalised. Raising concerns by staff should be welcomed, positively reinforced and acted upon so that it becomes routine and everybody’s business to identify and put right concerns early wherever they occur.
Doctors across Wales remain highly trusted among the public. Trust, honesty and integrity are central components of the doctor-patient relationship; the professionalism of doctors has enabled this quality relationship to remain intact. This is despite doctor’s workloads being stretched to the limit, despite feeling undervalued and isolated and despite investment on the NHS not keeping up with the rise in demand.
The delivery of care in the right place, at the right time, by the right professional requires robust workforce planning, an open and supportive workplace culture and evidence based policy making. Focusing on supporting the people of Wales to live healthier lives, creating a sustainable NHS and safeguarding the quality and safety of patient care will ensure high-quality and sustainable care for patients delivered by skilled and engaged expert staff.
With our fellow healthcare professions we are committed to working proactively to realise this vision.
You can find out more about BMA Cymru Wales’ priorities in our manifesto What about health? Three steps to a healthier nation.