Living and Working as a geriatrician in Wales

Dr Anthony James is a Consultant Physician at Princess of Wales Hospital. 

Why train, work and live in Wales and why do Geriatric medicine here? It isn’t an easy decision to choose a specialty or move to a different part of the country. Wales is often thought of for its castles, song, rugby, dragons and heavy industry in the way of Coal and steel.

The national health services was established on the 5^th July 1948 by Aneurin Bevan, a Welsh man, and today the National Health Service is Wales’ largest Employer.  In recent years the NHS in Wales policy has deviated from England’s version guided by the Wales Assembly Government (WAG) based in Cardiff.

An overview of the Policy Forum for Wales event

Hospital in Bridgend, Wales. He is a care of the elderly physician with an interest in Parkinson’s Disease and movement disorders.
Organised by the Policy Forum for Wales, this event which was held on 19 October, provided the Welsh Government, and other agencies, the opportunity to engage with key stakeholders and discuss public health policy issues that particularly affect Wales. This seminar was about involving health and social care senior policy makers in developing a vision for Wales and bringing together multiple organisations (public sector, voluntary and third sector) to have a dialogue about how best to influence the Welsh Government’s health and social care policies.

The day was kicked off by chair Mr Huw Irranca – Davies AM, with a cross party group on cancer introducing the theme of the day. This was followed by brief from Professor Siobhan McClelland on current trends in health care in Wales including a £700 million gap in the budget for health and social care (10% of the total health budget). She emphasised that service configurations should be decided according to local need rather than by committee or Government mandate.

The push to improve stroke services

Adhi Vedamurthy is a consultant geriatrician with a special interest in stroke, and Chair of the BGS Wales Council.

It was a typical Monday morning in a district general hospital. Loads of elderly medical patients had spent the night in the emergency department waiting for a bed. About a dozen ambulances were outside the hospital unable to offload patients.

I had just done a third of my ward round with the foundation year one doctor when the bleep went off. A patient with potential need for thrombolysis had just arrived. Apart from the stroke nurse, there was no other suitable senior doctor available to assess the patient.

I abandon the ward round to assess the patient, organise the scan, push the trolley with the stroke nurse to take the patient to the stroke unit and initiate thrombolysis. This takes nearly an hour. During this time, the patients on the ward are still waiting for my assessment and management plan. Two discharges get delayed and a few scans were not booked on time and they had to wait for another day.

This scenario is very common in many hospitals where geriatricians have more than one role. Time is of the essence when treating stroke patients, but this comes at a cost if commissioners do not invest to improve services and expect existing services to stretch. This also applies to therapy services who are asked to prioritise stroke patients.

To meet targets, a patient with a suspected stroke (many do not have a stroke) must get a bed in a stroke unit within four hours. But it seems entirely acceptable for patients with heart failure, pneumonia, a fall, delirium, etc., who have far higher mortality, to spend hours on a trolley in the emergency department.

There is no argument that acute stroke is an emergency and should be treated accordingly. However this should not come at the expense of other services in geriatric medicine.

A majority of geriatricians in Wales felt that an improvement seen in stroke services has come at the cost of compromising services in geriatric medicine.

Is this the case in the other devolved nations? I would love to hear your views.