Tag: Health

What’s in your medicine cabinet? The Public Accounts Committee inquiry into Medicines Management

Do you have concerns about the number of items on your repeat prescription?

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Have you experienced difficulties in getting the right medicine from a pharmacist? Have you had any problems while in hospital with incomplete drug charts meaning you got the wrong medicine?

These are some of the issues the Public Accounts Committee have been considering as part of their inquiry into Medicines Management.

With over £800 million spent on medicines and over 79.5 million medicines dispensed in Wales per year, NHS Wales uses medicine on a substantial scale. In the last 10 years there has been a 46% increase in the number of items dispensed, and in the face of this growing demand, Welsh Government is urging prudent prescribing, to optimise people’s medicines so that patients receive the best possible outcomes and so that the NHS gets value for money from medicines.

The Auditor General for Wales published a report on medicines management within primary and secondary care settings, on 15 December 2016. This looked at whether NHS Wales is managing medicines effectively, in primary care, in secondary care and at the interface between primary and secondary care. The report considered health bodies’ corporate arrangements for medicines management, such as strategic and workforce planning, the profile of medicines issues at Boards and committees, and arrangements for monitoring health bodies’ performance in relation to medicines.

The Auditor General concluded that:

  • There was scope to make prescribing safer and more cost effective within primary care;
  • There are medicine related safety risks and inefficiencies when people move in and out of hospital;
  • There are problems in hospitals with medicine storage, gaps in medicine information and frustration at delays in implementing electronic prescribing.

The Committee explored a number of these issues with the Welsh Government at our meeting in March 2017.

The Committee were concerned to find that it had taken so long to introduce electronic prescribing (this was first discussed in 2007, but is not likely to come in until 2023).

Another area the Committee felt could be improved was around developing a central system for very expensive medicines which are not run of the mill rather than each health board holding a store of the medicine.

Of particular concern to the Committee, was repeat prescriptions and whether all the medicines were being used or whether patients end up with stockpiles due to the difficulties of altering the prescription.  This is an issue as money is wasted every day through patients receiving medicines they do not really need and which may not be required. The Government explained to the Committee that this was a ‘tripartite thing’ with the patient, pharmacy and prescriber all having responsibility.

The Committee would be keen to hear your experiences around this, or any other part of medicine management –we would welcome hearing your experiences via twitter @SeneddPAC or by e-mail seneddpac@assembly.wales

Next steps:

The Committee will be taking evidence from Health Boards and Pharmacists to explore how well best practice is being shared and their response to some of the Committee’s concerns.

The full meeting held in March can be watched on Senedd TV and the transcript for the meeting along with all the written evidence received by the Committee to date can be access on the Public Accounts Committee page.  The June meeting will be available on Senedd TV.

What can Wales do to address loneliness and isolation?

Figures from Age Cymru show that 75,000 older people in Wales feel lonely or isolated. Almost half of those surveyed said the television or a pet was their main companion.

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The National Assembly’s Health, Social Care and Sport Committee has begun an inquiry looking how this issue affects older people in Wales. It will look at what support is available for older people and what more can be done to tackle the issue. The Committee will also look at the extent to which initiatives to combat loneliness and isolation experienced by other groups may also help older people.

There is evidence to suggest that loneliness and isolation can have a significant impact on physical and mental health and may be a cause of depression, sleep issues, stress, and even heart problems.

It’s therefore possible that preventing loneliness and isolation could  reduce the demand and pressure on health and social care services.

Loneliness and isolation are not the same thing – each can be experienced without the other. A person may feel lonely in a crowded room, isolated in a rural community or even vice versa.

The problem of loneliness and isolation has already been recognised by the Minister for Social Services and Public Health as an important public health issue, while the Older People’s Commissioner for Wales has made tackling the problem a priority.

The Welsh Government already has a set of indicators to check its progress towards the achieving its ‘well-being goals’ one of which is to monitor the ‘percentage of people who are lonely’.

The Committee will be looking at this complex subject and the  wide range of services which can have an impact on it such as health, social care and community services, transport and even internet access.

Chair of the Health, Social Care and Sport Committee, Dai Lloyd AM:

“Isolation and loneliness can affect anyone,  employed or retired, living in a town, city or the countryside.

We already know the issues affect a high number of older people. Tackling the problem could  both help individuals feel better and could also  mean less demand on our health and social care services.

If you or someone you know is, or has been, affected by issues of loneliness or isolation, or you are involved in work to support them, then we would like to hear about your experiences and what ideas you think could help.”

If you would like to contribute to the inquiry you can find more information, including how, on the Health, Social Care and Sport Committee pages on the National Assembly’s website.

The Committee will be holding a Facebook Live session on 25/01 at 17.00 to talk more about the inquiry and invite people to take part.

You can also keep up to date with what the Committee are doing via their Twitter account – @SeneddHealth.

Public Health (Wales) Bill: Tattooing, body modification and intimate piercing

Article by Amy Clifton, National Assembly for Wales Research Service, In Brief blog.

On Tuesday, 8 December 2015 the Assembly will debate the Public Health (Wales) Bill in Plenary. The Health and Social Care Committee, tasked with scrutinising the legislative proposal, issued a Report on the Bill last week and made a number of recommendations and suggested amendments.

At the start of the consultation, the Assembly’s Outreach team conducted a national survey to ask the people of Wales what they thought of the Welsh Government proposals relating to e-cigarettes, special procedures and intimate piercing.

Much of the attention surrounding the Public Health (Wales) Bill has focused on e-cigarettes. However another interesting area of the Bill concerns special procedures and intimate piercing (Parts 3 and 4 of the Bill).

Special procedures

The Bill as drafted would create a mandatory licensing scheme for practitioners and businesses carrying out special procedures in Wales. The special procedures currently included are acupuncture, electrolysis, body piercing and tattooing, although the Bill would also allow Welsh Ministers to amend this list through secondary legislation.

Many stakeholders indicated in their evidence to the Committee that there is currently a significant lack of quality control within the tattoo and piercing industries. The Committee heard alarming reports that many procedures are being done by people with little, if any, knowledge of anatomy, infection control or healing processes.

Stakeholders also highlighted additional procedures they believe should be included the Bill. These included body modification (scarification, dermal implants, branding and tongue splitting), injection of liquid into the body (botox or dermal fillers), and laser treatments (tattoo removal or hair removal).

The Assembly Outreach team made a short video, interviewing practitioners across Wales:

Tattoo artists in the video express particular concern about branding, scarification, ‘extreme body modification’ (such as tongue splitting and penis splitting) and dermal implants. They explain that scarification (where a section of the skin is removed to leave a scar) is often performed dangerously.

The tattooists also say that branding is being done with blowtorches and bent coat hangers, and adapted soldering irons, and describe concerns about dermal implants, such as inserting horns and stars under the skin:

Inserting foreign objects into your body is not a good thing without some sort of legislative weight behind it to say, ‘That’s unsafe’, or, ‘Is the material safe?’ or ‘Has it been checked?’; ‘Is it sterile? Have you autoclaved it before you put it in there? Where did you get it from? Has this come out of a five-penny ball machine round the corner?’

Intimate piercing

The Bill proposes to set an age restriction of 16 years old for intimate piercing. It defines the intimate body parts as the anus, breast, buttock, natal cleft, penis, perineum, pubic mound, scrotum and vulva.

Whilst there is support for the principle of an age restriction, many stakeholders believe that 18 would be a more appropriate minimum age limit for intimate areas. For example, the Chartered Institute of Environmental Health (CIEH) believes that 18 would be a more appropriate age restriction, as this is in line with the minimum age for tattooing, and reflects the level of maturity needed to make such decisions. Stakeholders also reasoned that an individual aged 16 is still growing and therefore the risk of damage to skin is greater. It was also noted that intimate body piercings require a higher standard of aftercare than tattoos, as they are potentially more susceptible to infection.

Dr Ncube supports a higher age limit, noting that there are long term implications with genital piercing. He gave a case study example of a father with a genital piercing, who was playing with his daughter, and his daughter accidentally kicked him.

The trauma that was caused by the genital piercing resulted in the formation of gangrene in his penis. It’s a condition called Fournier’s condition. Because of that, the scarring that occurred was profound. So, genital piercing is attended with considerable risks, and it’s not just the piercing alone that is important, but it’s the long-term implications of it.

There was also a strong message from stakeholders, including Public Health Wales, that tongue piercing should be included in this part of the Bill, with witnesses describing a high risk of complications, harm and infection.

Plenary debate

You can watch the debate on the Public Health (Wales) Bill live on senedd.tv or catch-up at a later date. For more information on the work of the Committee, visit their website on www.assembly.wales/seneddhealth

The National Assembly for Wales becomes a Slate Ambassador

Here at the National Assembly for Wales, we are always looking at new ways of sharing information in exciting and innovative ways. This year, we started using a product called Slate (made by Adobe) to give summary versions of reports produced by our committees.

Our Slates have been extremely successful – so much so that Adobe have made us a Slate Ambassador!

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What is Slate?

Slate is a platform that allows organisations to create and share interactive reports, information and presentations. It has accessible user interfaces and cross platform compatibility, the Assembly has used Slate to share the extensive and complex work of Assembly committees in an informative and easily navigated format.

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Slate success

Following the recent inquiry into Alcohol and Substance Misuse in Wales, the Assembly’s Health and Social Care Committee wanted to share their findings. The Assembly used Slate to create a summary of the committee’s work. Using eye catching imagery and informative content, a cross platform report with a friendly user interface was created.

“We have been blown away by the amazing things people like (The National Assembly for Wales) are doing with the tool”   – The Slate Web Team

Slate has now been used to present the findings of a number of Assembly committees including the Finance Committee enquiry into whether the Ombudsman should have more powers and the Communities, Equality and Local Government Committee enquiry into how poverty can be reduced in Wales.

Find out more about the work of Committees at the National Assembly for Wales

Chair’s blog: Health and Social Care Committee – looking back at the last five years

David Rees AM

I’m David Rees, and I’m the Chair of the Assembly’s Health and Social Care Committee.

The Health and Social Care Committee is a group of ten Assembly Members from across Wales, who represent the four political parties who make up the Assembly. Since 2011 our role has been to hold the Welsh Government to account on health and social care in Wales.

As the Committee’s work will come to an end before the Assembly elections next year (when people in Wales will get to choose who represents them for the next five years), we’re looking back over the past five years, and we want to know what you think.

We would like to hear views from everyone who would like to comment: those who have worked closely with us, those who have never engaged with us, and everyone inbetween.

We are gathering views from people across Wales on the past five years, including our way of working, the work we have done, and the impact it has had. We also want to hear about what the key challenges are going to be for health and social care in the next five years.

On that basis, thinking about the past five years:

  • How have we had an impact on health and social care in Wales?
  • What has been our biggest achievement?
  • If we could have done one thing differently, what would it be?
  • Have we struck the right balance between scrutiny of policy, finance and legislation?

And thinking ahead to the next five years:

  • What do you think will be the three biggest challenges for health and social care in Wales?

So if you have a view on these questions, please download a consultation response form or write to us at SeneddHealth@assembly.wales.

Please make sure that your response is with us before 25 September 2015.

What happens then?

We will consider all of the responses we receive when we’re looking at our legacy, and will publish our conclusions before the end of the Assembly.

Where can you find out more information?

National Assembly pledges to become a dementia-friendly organisation

What is dementia?

The word dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. It is not a disease in its own right and it is not a natural part of ageing. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes. Dementia is progressive, which means the symptoms will gradually get worse.

Find out more about dementia by visiting the Alzheimer’s Society website or watching their short video ‘What is Dementia?’.

Dementia affects over 750,000 people in the UK and there are 45,000 people living with dementia in Wales.

What does the Assembly becoming a dementia-friendly organisation mean?

A dementia-friendly Assembly is committed to helping to raise awareness and understanding of dementia amongst Assembly Members, and the wider Assembly community.

“By extending its equality of access to people living with dementia, the National Assembly for Wales will be demonstrating that people with dementia are both welcome and able to participate in civic life,” said Sandy Mewies AM, the Assembly Commissioner with responsibility for equalities issues.

The Assembly will:

  • Champion the rights of the 45,000 people living with dementia in Wales, and those who care for them.
  • Ensure Alzheimer’s Society’s Dementia Friends information sessions are delivered to public facing staff so they are equipped to respond to external visitors living with dementia.
  • Ensure staff who have caring responsibilities for people living with dementia are directed to support available through the Alzheimer’s Society.
  • Provide Dementia Friends information sessions for Assembly Members, their staff, Assembly Commission staff, and contractors working on the estate so that they are equipped to assist constituents and people they come into contact with who are living with dementia. In fact, to date almost half of Assembly Members have already become Dementia Friends.

Sue Phelps, Director of Alzheimer’s Society in Wales said:

“We are delighted that the National Assembly for Wales has made this commitment. Their pledge supports Alzheimer’s Society’s drive to encourage communities, businesses and other organisations to work towards becoming more dementia-friendly and help to create better environments for people to live well with dementia for as long as possible. We need everyone to act now to make changes to empower people with dementia and help them live well in their communities.”

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Chair’s blog: Safe Nurse Staffing Levels (Wales) Bill

david rees

The Safe Nurse Staffing Levels (Wales) Bill’s main aim is to ensure that enough nurses are available to deliver safe nursing care for patients at all times. It was introduced by Kirsty Williams AM in December 2014 and has been considered by the Health and Social Care Committee during the early months of 2015. We reported on the Bill in May 2015:

Safe Nurse Staffing Levels (Wales) Bill: Stage 1 Committee Report (PDF, 933KB)

The Assembly will consider this Bill in the @SeneddChamber on 3 June. At the end of the debate on the Bill, all Assembly Members will be asked to decide whether or not it should be allowed to progress to the next stages of scrutiny.

What does the Bill seek to do?

The Bill’s purpose is to require health service bodies to make sure that:

  • there are enough nurses available to give safe care to patients all the time; and
  • the management and planning of the nursing workforce in Wales is good, safe and efficient.

What did we think about the Bill?

Our job as a Committee at Stage 1 is to consider whether legislation is needed to deliver the aims set out by the Member who is responsible for the Bill, or whether there are better ways to do that.

To help us come to a conclusion on this question, we sought as many views as possible. We received 34 written responses and invited 32 individuals, including Kirsty Williams AM and the Minister for Health and Social Services, to provide oral evidence in the Senedd.

After considering the range of evidence we received, including information from doctors, nurses, other health professionals and patients, we concluded that legislation could help improve the delivery of safe nurse staffing levels in Wales. While we unanimously supported the Bill’s aim, we made 19 recommendations we think should be implemented before the legislation is passed. Many of our recommendations focus on our concerns that the Bill could lead to a number of unintended consequences, not least the risk of diverting nursing staff from one hospital setting to another. We are also concerned that current nurse shortages may be a significant barrier to the successful implementation of the Bill’s provisions.

Our recommendations include:

  • making sure that health bodies’ compliance with staffing ratios in “adult inpatient wards in acute hospitals” does not have an adverse effect on nurse staffing levels in other NHS settings in Wales;
  • asking the Minister to ensure there is guidance in place to guard against the possible unintended consequences arising from this legislation;
  • ensuring a balance between the use of permanent and temporary staff when complying with the staffing ratios;
  • giving consideration to including reference to arrangements for comprehensive workforce planning on the face of the Bill, to ensure that sufficient numbers of trained nurses are available across public and independent sectors; and
  • providing clarity about the settings to which the Bill will apply.

You can read our full list of recommendations, and the evidence that underpins the conclusions we have drawn, in our report:

Safe Nurse Staffing Levels (Wales) Bill: Stage 1 Committee Report (PDF, 933KB)

Photo of the front cover of "Safe Nurse Staffing Levels (Wales) Bill: Stage 1 Committee Report"

What happens next?

If the Assembly agrees the general principles of the Bill on 3 June, the Bill will proceed to Stage 2. Stage 2 will start on 4 June. During this stage, committee members will look at every line of the Bill and propose any amendments they think are needed to improve it. These amendments will be discussed in a committee meeting, currently scheduled for 9 July 2015.

If the Assembly does not agree the general principles of the Bill, the legislation will fall and no further proceedings relating to the Bill will take place.

If you want to learn more about how legislation is considered by the Assembly, you can find information about the process on our legislation webpages.

How to get involved and keep up-to date with the Committee’s work