The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

Rural doctors and public health doctors will be pleased with the response from the BMA Wales to the Green Paper. The most important parts relate to culture, to the disengagement of professionals, and the lack of honesty. But will politicians take any notice? Rather like Mark Britnells book In Search of the Perfect Health System ( a new book reviewed ) it might remain on the shelf…

NHSreality notes the paragraph in the BMA response ( Our health, our health service BMA response) to that part of the Green Paper covering candour (honesty with individual patients):

“However, we do support placing statutory duty of candour on organisations as we believe that the existing mechanisms for holding providers to account require strengthening.
It is our observation that members of the medical profession have been encouraged to be open an honest with patients when things go wrong, but that health bodies have become more secretive and less open with patients. This is leading patients and their families to complain and assert that aspects of their care are being concealed or covered up. We perceive this is often related to fear of litigation or public criticism by health boards, but we feel this needs to be addressed; health bodies need to recognise that they work for patients, and not the other way around.”

The Green Paper itself can be downloaded by clicking here.

Support for a profession disillusioned and disengaged from the politics of health is not addressed adequately by the Green Paper. Mentoring and psychological support systems for Consultants and GPs are badly needed.. A Balint group availability in each trust could help..

With regard to honesty about rationing, and candour with the population rather than the individual, the document reads:

“BMA members in Wales have also raised the need for more honesty in the language that may be used. The Welsh Government and Welsh health bodies need to be more upfront in acknowledging that resources are finite. The discussion and implementation of rationing should therefore be more overt so that patients can be clear upfront what services can or cannot be provided. It may also be helpful to provide greater transparency to patients regarding the actual costs of treatments.”

On the need for depersonalised and summarised EXIT INTERVIEWS (by an independent third party the paper reads:

“We would also suggest that any staff leaving the employment of the NHS in Wales should be subject to an exit interview. This can help in identifying areas that might need addressing by giving staff an opportunity to raise issues they might have been fearful of raising during the time of their employment”

Community Health Council) for digestion by Health Boards and Politicians. Exit Interviews are a rare occurrence in and across the different UK Health Services…..

We all know that there is a less and less National, and more and more Regional health service… Wales has an advantage in not recommending choice, which may help the finances, but when patients live on the border this just provides a perverse incentive to game the system … Wales is too small and adjacent to the large gravitational pull from England. This means all policies different to the English ones will be distorted…

GPs on the press/media rack. The Balint approach.

Mental health still surviving on the crumbs

A first debate in West Wales BMA – on rationing – wins a majority in favour








This entry was posted in A Personal View on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

2 thoughts on “The Welsh Green (nearly white) paper on Health – and the BMA Wales response. The candour of honest language and overt rationing, & exit interviews to lever cultural change..

  1. Pingback: The BMA Hustings – an uninformed line up of hopeful politicians. Withybush Hospital degenerates further. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Pingback: The “N”HS is a lie. Politicians have a duty of candour. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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