P 54
Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
Inquiry into the Priorities for the Health, Social Care and Sport Committee
Ymateb gan: Colleg Brenhinol Meddygon Caeredin
Response from: Royal College of Physicians of Edinburgh
The National Assembly for Wales
Priorities for the Health, Social Care and Sport Committee
Response from the Royal College of Physicians of
Edinburgh
1. The Royal College of Physicians of Edinburgh (RCPE) is an independent clinical standard setting body and professional membership organisation, which continually aims to improve and maintain the quality of patient care. Founded in 1681, we support and educate doctors in the hospital sector throughout the UK and the world with over 12,000 Fellows and Members in 91 countries, covering 30 medical specialties.
2. Physicians are leaders within healthcare teams and engage in
difficult discussions about prognosis and treatment options. Our
members have identified three key priority areas to inform the
health goals of the incoming Welsh Government in 2016. These
measures will ensure safe, patient-centred, high quality medical
care (1) and improved public health. For more information on any of
these issues, please contact us directly: XXXXXXXXXX or XXXXXXXXXXX.
Health and wellbeing
3. The RCPE has worked to improve public health for nearly 350
years and promotes health and wellbeing for all.
4. Obesity: 58% of all adults in Wales are overweight (2)
compared to 39% globally (3) and 62% of the UK (4). Prevention is
both better for patients and more cost-effective than treatment.
However, action is also necessary to assist those who are already
overweight or obese. The costs of obesity to both the NHS and
patients are high (5), financially and in terms of avoidable
suffering. Being overweight increases the chances of developing
diabetes, heart disease, cancer and arthritis, and has the
potential to lead to reduced mobility, disability and social
isolation.
5. It is vital that the public can make informed choices about
food. While a balanced diet will help avoid obesity, a poor diet
which does not meet recommended dietary requirements and results in
overweight/obesity could be described as ‘modern
malnutrition’ (6). Preventative measures such as
reduced food portion or pack sizes must be considered along with
policies such as the sugary drinks tax.
6. The RCPE supports fully embedding physical activity for health
into primary care, secondary care, social care and health
education,(7) as well as in the health and social care workforce
and workplace. This would include ensuring secondary care staff
provide guidance on the recommended minimum levels of physical
activity for health, offer brief advice and brief intervention, and
signpost to community resources.
7. Alcohol: Problems associated with alcohol continue to be
a challenge for the NHS in Wales. We agree with other health
organisations that the alcohol industry should have a reduced role
in the formulation of alcohol policies to help ensure public health
remains the priority. The alcohol industry should be strongly
encouraged to contribute to the reduction of alcohol harm by
sharing knowledge of sales patterns and marketing influence. The
implementation of Minimum Unit Pricing (MUP) remains a priority for
the RCPE and we ask the Welsh Government to support this.
8. Tobacco: 20% of adults were active cigarette smokers in
2014 (8). While this figure is gradually falling, we ask the
Government to continue to support Stop Smoking Wales and targeted
initiatives in order to see further long-term improvements and
reduce premature deaths. We also call for a dementia prevention
strategy which recognises that smoking is a major risk factor (9)
for developing dementia, and thus would be a crucial part of any
prevention work.
9. Mental health: There is a well described link between
mental and physical health and wellbeing, (10) and we therefore
support extending the integrated and holistic view taken in the
Mental Health (Wales) Measure 2010. The Measure is intended to
ensure that where mental health services are delivered, they focus
more appropriately on people’s individual needs. Around 30%
of people with a long-term physical health condition also have a
mental health problem. The evidence also shows that that people
with mental health issues are dying early due to associated
physical behaviours and that, for example, stopping smoking
improves mental as well as physical health (11). Mental
health promotion should be given more prominence with respect to
physical health due to the burden of morbidity and reduced life
expectancy
10. Inequalities: There are currently significant
differences – up to 10 years – in life expectancy
between the most affluent and the most deprived areas in Wales
(12). Research over the years, from the Black Report (13) to Prof
Sir Michael Marmot’s Institute of Health Equity, (14) has
consistently shown that it is vital that action is taken to improve
the social and economic conditions in which people live (15). We
therefore call on the Government to pursue policies which will
address social determinants of ill health and improve circumstances
which lead to poor health or social exclusion, including
disability.
11. The RCPE is committed to working with other organisations and
professional bodies to embed action on the social determinants of
health across the workforce. We ask the Government to support these
measures.
12. Overtreatment: Issues such as the overuse of clinical
treatments and interventions (16) and the overuse of antibiotics
(17) remain high profile and we call for partnership-working
between clinicians and the Government to ensure tackling these
issues remains a priority and best practice is followed to maintain
the efficacy of some of our most clinically valuable
medicines.
Workforce planning and training
13. Workforce planning: The RCPE supports increased
availability of consultant-delivered care, including at evenings
and weekends, where there is potential to improve quality of care
for patients with the appropriate staff and services in place. It
is essential that an evidence-based approach to extended working is
taken, recognising the importance of a multi-professional approach
and an appropriately phased implementation. We call on the
Government to recognise that this cannot be delivered without
additional resource, increased medical staffing, clinical time, and
increased support from services such as radiology; pathology and
allied health professionals (AHPs).
14. Collaboration is vital between the Government and clinicians to
build upon the emerging evidence in this area, such as the findings
of the RCPE’s expert workshop on extended working. The
medical workforce faces a number of challenges and the RCPE
recognises the need for safe and sustainable staffing levels
throughout the NHS. We need to ensure that we continue to recruit
and retain a world class workforce to deliver the best possible
patient care (18). The RCPE is committed to working with the Welsh
Government and other allied organisations to address issues around
recruitment and retention such as consultant vacancies, rota gaps
and trainee attrition rates, as a matter of priority. We are also
committed to working with partner organisations to promote
innovative ways of working in the NHS. The roles of Physician
Associates, Advanced Nurse Practitioners and other examples of
physician extenders should be further examined to create a
workforce fit for the future.
15. Political parties must commit to developing and implementing
minimum staffing levels for all professions within hospital
settings, based upon best evidence (1), along with improved
workforce planning which reassesses the size and structure of the
consultant workforce taking account of such changes as the rise of
part-time working, extended working, and the needs of an ageing
population.
16. The College is committed to promoting the highest clinical
standards and implementation of robust, evidence-based medical
practice. Standards must be measurable and the associated scrutiny
proportionate in order to be effective. Improving patient flow
across health and social care remains vital in this regard, both in
terms of patient safety and quality improvement (19). Patients must
be treated in the right place, and as quickly as possible. This
requires the right numbers of staff and mix of skills across health
and social care.
17. Training: Excellent training is essential to provide
excellent patient care. Doctors in training provide a significant
level of core hospital services and care, and are key in
identifying concerns in service provision and standards of patient
care. Our trainees will become future NHS leaders and the
RCPE is committed to supporting them throughout their careers.
18. The RCPE calls for the incoming Government to ensure that: UK
wide training standards, as regulated by the GMC, must be met
throughout Wales; development of Shape of Training should be
conducted in Wales with input from the RCPE and implementation must
be appropriately evaluated; medical Royal Colleges need to be able
to devise curricula according to patient need, independent of
government involvement; training and service are inherently linked
and both must be supported in order to deliver high quality patient
care. Full adoption of the RCPE’s Charter for Medical
Training (20) provides this environment.
19. All medical units admitting acutely ill patients must be
staffed by doctors in training at registrar level possessing the
MRCP (UK) examination, or equivalent Staff, Associate Specialist
and Specialty
(SAS) grade doctors, working under the direct supervision of
consultant staff, all on robust and sustainable rotas. A healthy
working environment must also be ensured by, for example, a zero
tolerance approach to bullying, harassment or undermining
behaviour.
Health and social care
20. Frailty: Current projections suggest that the number of
people aged 65 and over will increase in Wales by 50% by 2037 (21)
and a significant problem faced by older people is frailty. Frailty
is progressive and impacts adversely on life experience (22).
We call on the incoming Government to continue exploring new
models of approaching patients with frailty which will assist in
routinely identifying those living with frailty and signpost them
to the most appropriate support, including self-management or care
in a community setting.
21. Long-term conditions: Managing patients with long-term
or chronic conditions is one of the biggest challenges facing the
NHS in Wales and collaboration between health and social care has
great potential in this regard. We ask the next Government to
actively support primary and secondary care to work effectively in
partnership with social care. It is important that, where
appropriate, patients are treated in a community setting and are
empowered to be active participants in their own care where
possible, and that patients fit for hospital discharge can do so
without delay.
22. We call on the Government to ensure that consultants and other
members of multidisciplinary teams have adequate time for patients
with long-term or chronic conditions to promote patients’
understanding of their own care, and for patients to have improved
access to specialist nursing care. An important part of providing
high quality patient care is ensuring that patients are well
informed and have accurate expectations of their treatment and
care: effective and compassionate communication with patients will
remain a key priority for the RCPE.
References
1 Bell D, Jarvie A. Preventing ‘where next?’ Patients, professionals and learning from serious failings in care. J R Coll Physicians Edinb 2015; 45: 4–8. http://dx.doi.org/10.4997/JRCPE.2015.101
2 House of Commons: Briefing Paper, Number 3336, Obesity Statistics. 2 February 2016
http://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf
3 WHO Factsheet. Obesity and overweight. January 2015.
http://www.who.int/mediacentre/factsheets/fs311/en
4 Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–81. http://dx.doi.org/10.1016/S0140-6736(14)60460-8
5 NICE. Preventing obesity and helping people to manage their weight. NICE advice [LGB9]. May 2013. https://www.nice.org.uk/advice/lgb9/chapter/economic-impact
6 Faculty of Public Health. Food Poverty and Health. May 2005.
http://www.fph.org.uk/uploads/bs_food_poverty.pdf
7 The Scottish Academy of Medical Royal Colleges and Faculties Pledge on Physical Activity.
http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf
8 Welsh Government. Welsh Health Survey 2014. 7 October 2015.
http://gov.wales/statistics-and-research/welsh-healthsurvey/?lang=en
9 ASH Scotland. Smoking and Dementia. May 2013.
10 Faculty of Public Health. Relationship with physical health and healthy lifestyles.
http://www.fph.org.uk/relationship_with_physical_health_and_healthy_lifestyles
11 ASH Scotland. Smoking and mental health: a neglected epidemic. June 2015.
http://www.ashscotland.org.uk/media/6418/ASHScotlandSmokingandmentalhealth.pdf
12 Welsh Government. The Wales We Want.
13 Gray AM. Inequalities in health. The Black Report: a summary and comment. Int J Health Serv 1982; 12:349–80. http://www.ncbi.nlm.nih.gov/pubmed/7118327
14 UCL Institute of Health Equity.
http://www.instituteofhealthequity.org
15 UCL Institute of Health Equity. Working for Health Equity: The Role of Health Professionals. March 2013. http://www.instituteofhealthequity.org/projects/working-for-health-equity-the-role-of-healthprofessionals
16 Academy of Medical Royal Colleges. Choosing Wisely Programme – A Briefing.
http://www.aomrc.org.uk/doc_download/9830-choosing-wisely.html
17 NICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE guidelines [NG15]. August 2015. http://www.nice.org.uk/guidance/ng15
18 Academy of Medical Royal Colleges and Faculties in Scotland (Scottish Academy). Learning from Serious Failings in Care. May 2015. http://www.scottishacademy.org.uk/documents/final-learning-from-serious-failings-in-care-execsummary-290615.pdf
19 RCPE UK Consensus Conference statement. “Acute Medicine: Improving quality of care through effective patient flow – it’s everyone’s business!” 15–16 November 2013.
http://www.rcpe.ac.uk/sites/default/files/files/final_statement_patient_flow_.pdf
20 RCPE Charter for Medical Training.
http://www.rcpe.ac.uk/policy-standards/chartermedical-training
21 Welsh Government. The Wales We Want – Demographics factsheet.
http://thewaleswewant.co.uk/sites/default/files/Demographics%20factsheet.pdf
22 Professor John Young, NHS England’s Director for Integration and Frail Elderly Care