Health Boss Maria Battle Answers Your Questions - Part 2
TheSprout has teamed up with the Cardiff Partnership for a series of interviews with the leaders of Cardiff's main institutions, and this week we interviewed the Chairperson for the Cardiff and Vale University Health Board (CVUHB), Maria Battle.
We asked for your questions and we only went and ruddy asked them. So without further ado, here's the person in charge of health in Cardiff answering your questions on paying for the NHS, the effect of immigration, and what the CVUHB is doing to support our ageing population.
(Maria provided really detailed answers to all of your questions, so we've had to break this interview down into a few articles. Keep checking back to find the answer to your question. Read Part 1 here!)
A Sustainable NHS (paying for the NHS) - continued
Q4. Should the taxpayer pay for obesity- and smoking-induced illnesses or injuries that are treated by the NHS or should the patient pay - at least something - towards their own treatment? Do you believe that the tax placed on cigarettes adequately covers their cost to the Welsh NHS?
I'm proud to be part of a publicly-funded NHS, and it was founded on the principle of being free at the point of use, and no political party supports the introduction of payments for routine NHS treatment. In local forums discussing this matter, young people and adults are both sympathetic to the idea of payment. In particular, the Cardiff group was more open to the idea of paying, while the Vale group was more intent on education and supporting those who need treatment.
- However, we do want to support local residents to help themselves stay healthy for as long as possible, by improving their diet, getting more exercise, stopping smoking (if they smoke) and being sensible about the amount of alcohol they drink.
- The UK Treasury receives around £9.5 billion pounds each year from tobacco duties and another estimated �2.6 billion in VAT. Estimates suggest that it may cost the NHS around £2 billion a year to treat diseases caused by smoking.
- There are also other costs to society, such as lost productivity, smoking-related sick days, social care, and the costs of fires. These are much harder to estimate but research suggests they may reach £10.9 billion each year.
- The primary aim of tobacco duty is currently to reduce smoking by making it less affordable, rather than to cover the costs to the NHS of smoking. It is estimated that for every 10% price increase in tobacco, around 3,000 lives are saved each year.
- Here in the Vale, we do have a prevention strategy, where those who need surgery and smoke must complete a smoking cessation course before we operate on them. (Unless it's a Clinical operation and the clinicians have the final say.)
Q5. Is there more that could be done working with social care to improve services?
- We are working closely with the Local Authorities and the Third Sector in Cardiff and the Vale of Glamorgan to do just that currently. We've already made great progress - some of you may already be aware of our Community Resource Teams which combine health, social care and third sector staff to provide post and pre hospital care in people's homes. That's making a real difference to people's lives and we can demonstrate how they work to rebuild the confidence of people who have suffered illness or injury so that they can return to as normal a life as possible. But, we do need to work more with housing, and more with the private sector.
- We plan to build on this over the next few years to make sure that our services are aligned together to focus upon individual needs and maintain them as much as possible within their own homes. But I don't think that we can focus only upon social care. We need to develop stronger partnerships with colleagues in housing, the third sector and also the private sector so that together we can create the right balance of support for people to regain as much independence as possible.
Q6. What are your views on e-cigarettes? Do they help wean smokers off cigarettes and so help the Welsh NHS or do they encourage young people to take up smoking by normalising it?
- The UHB is committed to improving the health of our population and reducing the number of people who smoke is a priority target. We will support all methods which help people quit smoking and are shown to be safe, effective, and which represent good value for money for the taxpayer.
- There is currently a lot of controversy around e-cigarettes, much of it because the evidence is not yet clear on their benefits or potential risks. While most experts tend to agree that regulated, controlled e-cigarettes are likely to pose a significantly lower risk to health than tobacco, the long term effect of nicotine itself is still not known, and unregulated and uncontrolled products can pose an unknown risk because the ingredients, for example, will vary from product to product.
The UHB therefore recognises that e-cigarettes may have a role to play in helping smokers quit, such as in the home or car. It is important to note however, that:
- Promotion must not appeal to non-smokers, in particular children and young people. This could include product appearance and packaging being plain in order not to attract people into using it. There should be no flavoured products
- Research is still needed to increase our understanding of e-cigarettes - in particular the safety; effectiveness; role in normalising smoking behaviour and role as a gateway to nicotine addiction and smoking, particularly in children
- Our current UHB No Smoking and Smoke Free Environment Policy states that the use of e-cigarettes inside hospital premises is not permitted. However, we will continue to review our policies in light of evidence and Welsh Government guidance and policy.
- Smokers can access support from 4 services, Stop Smoking Wales 0800 085 2219, our UHB based Smoking Cessation Service 02920 743582, from their GP or from a Community Pharmacy participating in our approved enhanced service offering specialist support. 15 Pharmacies across Cardiff and Vale of Glamorgan are offering drop in services where smokers can access free Nicotine Replacement Therapy (without visiting their GP first for a prescription).
Drugs and alcohol
Q7. Why is alcohol legal when other drugs are not?
- The decision for some substances to be illegal, whilst others are not, sits with the UK Government. We do however support the lobbying role that Welsh Government undertakes relating to alcohol such as the plans to introduce a minimum unit price for alcohol, and for alcohol licensing to be devolved to Wales.
- We recognise that alcohol causes less harm than many other substances, provided that people follow the government advice; that is to drink within the recommended daily limits (2-3 units a day for a woman, and 3-4 units a day for a man). Also that everyone should try and have at least two alcohol free days every week as a minimum.
- Alcohol causes significant harm to people across Cardiff and the Vale through a number of alcohol related illnesses such as liver disease and the risk of developing a dependency or addiction to alcohol. Sticking to the advice and guidance on how much to drink, and how often will reduce the risk of these problems occurring.
Q8. The Advisory Council on the Misuse of Drugs (ACMD) said that the latest data showed that 400,000 (7.6% of) young people aged 16 to 24 had tried laughing gas (nitrous oxide) in the past 12 months and it was now the second most popular recreational drug in Britain (after cannabis). What are the potential medical effects of trying nitrous oxide?
- Nitrous oxide or laughing gas is legitimately used in medical procedures in order to numb pain and reduce patient anxiety in medical procedures. However, it is strictly and carefully controlled by qualified clinical practitioners in these instances. It is also used in the technology and catering industries.
- Nitrous oxide causes dizziness, euphoria and can cause hallucinations - therefore the immediate risks of use are the problems that can arise from a loss of judgement, causing people to act carelessly or dangerously; putting themselves at risk of harm. Severe headaches can also be an immediate side effect.
- A more dangerous consequence can be oxygen starvation if nitrous oxide is used frequently in a short space of time or in an enclosed environment with a risk of asphyxiation.
- People should also be aware that heavy regular use of nitrous oxide can lead to deficiency of vitamin B12 and a form of anaemia. The Severe B12 deficiency can lead to serious nerve damage in some cases, which causes tingling and numbness in the fingers and toes and other extremities, and even difficulties with walking and pains in affected areas.
- The Health board in partnership with all other public services across Cardiff and the Vale are dedicated to reducing the harm caused from the use of substances, and we are working hard to make sure that there are effective support services in place for people looking for advice, information and support. There is a wave of new substances becoming ever more popular and available, and we are making sure that all our services are geared up to providing the most up-to-date and relevant advice and information. For young people, the Red Button website provides a one-stop-shop of information advice and support for anyone needing to know more about drug and alcohol issues.
- There are a number of ways people can access their five a day from market stalls to community cafes, like the refurbished Dusty Forge which recently opened in Ely. There are lots of Food Co-ops across the city where people can purchase bags of fruit and veg for £3 a bag - have a look on Food Cardiff?s website to find a list - foodcardiff.com/find-my-nearest
- Many of these co-ops and shops across Cardiff also accept Healthy Start vouchers which are available to spend on milk, fruit and veg for families on certain benefits. You can check eligibility and search for shops here.
Q10. It's obviously much better to educate our citizens to be healthy rather than just providing services to treat people when they are sick. Food has a tremendous influence on our health, even more than exercise.
a) What initiatives/projects are being considered to:
a) provide the correct Information
b) regulate the marketing of health damaging products
c) practical help for people who want to change but don't know how
- The UHB and Cardiff Council host Food Cardiff, an award winning movement that is working in partnership across the city to address all these issues and more. They network with local partners in the city such as Community First Teams and Public Health Dieticians on initiatives such as community cafes, school holiday food provision, nutrition skills training and Food Co-ops.
- They have been on the TV too in England and Wales on the recent Farmer and the Food Chain programme and their food and fun pilot which opened up schools over the summer to provide a programme of fun activities together with breakfast and lunch was described by BBC Wales Today as a "lifeline for parents". This project has just been shortlisted for a Sustain Wales Award. You can find much more on the Food Cardiff website, or follow them on Twitter @fairfoodcardiff.
Q11. I stayed in hospital in Cardiff last year and was shocked at how hard it was to get a vegan option at meal times. Unfortunately some of the meals on the vegan menu contained Quorn, which as we all know contains egg and or milk. At least those working in catering at a hospital should know what is in the food and what a specific diet consists.
- I am genuinely sorry that the right food wasn't made available to you. We recognise that current menu has limited vegan options (3 main meals) but if patient is in for long time, dieticians work with the individual to meet their needs.
- We are currently reviewing our menus to improve choices for patients which will significantly extend the menu, including more vegan options
- All meals are methodically coded, so no vegan meal should contain any Quorn.
Q12. Can the hospitals start serving healthier food and have some understanding of healthy eating?
- Absolutely. In Cardiff we have a healthy vending policy that all hospitals comply with. Now we are working hard on a new set on standards that will mean that the food available to staff and visitors in our hospitals will be as healthy as possible whilst still providing a wide range of choice.
Q13. Lots of young people drink energy drinks and it's been reported that there has been a rapid rise in their popularity in recent years (Cardiff University, 2015), prompting concerns about their high sugar content, the risk of sudden cardiac arrest, high blood pressure, caffeine culture and dependency, behavioural issues, and so on. Do you think that they should be banned from schools and should there be a minimum pricing?
- In Cardiff and the Vale of Glamorgan we are very fortunate to have funding for a multi-agency team, Switched On to work with schools to increase knowledge among young people and school staff around substance misuse. The issue of energy drinks arises both from a substance misuse and dietary perspective. The recommendation from both members of Switched On and Cardiff and Vale Healthy Schools teams is for schools to educate pupils about the dangers of drinking energy drinks, recommending healthier alternatives, and to discourage their use by banning them from sale. Some schools already ban energy drinks but enforcement can be an issue even when a ban is in place.
- It is also important that shops should be encouraged not to sell to under 16s. Energy drinks can certainly be very cheap, with recent reports of cans being sold for only 19p, so it would seem sensible to consider minimum pricing, but this would need to be discussed at a Wales-wide level.
Q14. Does Great British Bake Off encourage unhealthy eating (and should it be banned?!)?
- Everyone deserves a treat from time to time and the fact it connects people with food and cooking is great - we just don't want everyone to be eating cakes on a regular basis. Of more concern are sugary drinks which are so common, and the hidden sugar in our food, which contribute to the current obesity, diabetes and dental crises.
Part 3 will be up soon! Keep checking back to see what the answer was to your question...
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