The Chief Medical Officer for Wales (CMO) published his third annual report, Valuing our health: Chief Medical Officer for Wales annual report 2018 – 2019 (PDF, 2MB), on 7 May 2019. The National Assembly for Wales will debate the report on Tuesday 14 May 2019.
The report focuses on four areas: the state of our health; prudent and value based healthcare; valuing research and working together to protect the public from health threats.
The state of our health
The first chapter of the annual report provides information on the health of the Welsh population. It identifies some of the key health challenges for Wales, including:
Life expectancy
- Since 2010 the UK along with several other countries has seen a slowdown in improvements to life expectancy.
- There remains a significant difference in life expectancy and healthy life expectancy between the most and least deprived areas in Wales; with an approximate eight-year gap in life expectancy and 18-year gap in healthy life expectancy.
Obesity
- Obesity levels continue to be concerning, particularly in relation to children, with physical activity levels and diet contributing to this.
Older people
- Wales has a higher proportion of older people than the rest of the UK, and therefore has a higher number of people suffering from chronic conditions and frailty. With more people living longer, the number of dementia cases will continue to rise.
Smoking
- The use of tobacco remains the leading single cause of premature death in Wales and a major contributor to health inequalities. Although smoking-attributable mortality has decreased in Wales, Public Health Wales estimate it is still accountable for over 5,000 deaths each year.
Information is given in this chapter on actions that are being taken to address some of the issues presented.
Prudent and value based healthcare
Chapter 2 of the report looks at prudent healthcare. Reference is made to how health services will manage in the future, with the population growing increasingly older and having more complex health and care needs, the CMO states:
We simply cannot keep doing things in the same way, spending money in the same way and hoping for different results. We must focus the system on delivering the best results it can for people, within the available resources. [p11]
The report sets out the prudent healthcare principles:
- For the public and professionals to be regarded as equal partners through co-production and shared decision-making.
- To prioritise those in greatest need.
- To aim to meet people’s health goals in the least invasive way possible in order to improve outcomes and minimise harm.
- To use evidence to reduce unwarranted variation in care across Wales to ensure fairness, improved outcomes and the reduction of waste.
The report discusses each of the principles in turn, along with some case studies. The CMO believes there is significant professional awareness of prudent healthcare although there may be barriers in relation to its consistent implementation.
The CMO makes 12 recommendations in relation to prudent and value based healthcare.
Valuing research
Chapter 3 of the annual report deals with research and innovation. The CMO views research as ‘vitally important to the economy of Wales; to the effectiveness and efficiency of health services; and to the sustainability of our NHS’.
The report notes that through Health and Care Research Wales, the Welsh Government funds a research infrastructure that comprises 5 research centres, 3 research units, 3 clinical trials units, and 3 support groups. The centres and units cover a diverse range of research, including mental health, primary and unscheduled care, population health and wellbeing, cancer, ageing and dementia.
HealthWise Wales is Wales’ national project to better understand and improve the nation’s health and care. It aims to collect detailed health and lifestyle data from as many people in Wales as possible to inform new treatments, health policy and NHS and social care services long into the future. More than 25,000 people across Wales have already registered.
At the beginning of the report, the CMO refers to childhood obesity, and in this chapter, information is given on how Wales is pioneering steps to tackle this into the next 70 years through research using health and activity data from primary and secondary schools, and trials aiming to boost activity by giving young people greater choice.
Also in this chapter, detailed information is given on Wales’ role in the genomic revolution and a number of case studies are provided throughout the chapter.
The CMO makes three recommendations in relation to the value of research.
Public health protection
The final chapter of the report considers some of the challenges relating to health protection:
Threats from Antimicrobial Resistance
Some progress is said to have been made relating to antimicrobial resistance, but the CMO states that more work with GP practices is needed to ensure appropriate antibacterial use.
Threats from vaccine preventable diseases
Each year has seen an increase in the number of individuals who get vaccinated against flu and the vaccination programme has been expanded in schools and to staff working in adult residential care homes and nursing homes.
The UK has again retained its status of effectively eliminating measles . The 2017–18 annual report on vaccine uptake in children in Wales shows that uptake of the first dose of MMR vaccine in two year old children remains below 95 per cent and the uptake of two doses of MMR by children aged five years was below 90 per cent. The report notes that there are currently a large number of measles outbreaks in many countries in Europe and 2017–18 saw measles cases in Wales imported from these affected countries. The CMO believes that Wales can expect these sporadic cases to continue while so many children in Wales are unprotected.
Threats from treatable communicable diseases
The NHS in Wales is said to have made a good start in eradicating hepatitis B and C as a significant public health threat but the CMO believes there are challenges to overcome if it is to succeed. Testing and treating in the community must become a reality to achieve the commitment.
The report highlights that sexually transmitted infections continue to rise. Nine key recommendations made by a Public Health Wales review have been accepted by the Welsh Government and are being taken forward under the oversight of the Sexual Health Programme Board.
Threats from our environment
Exposures to environmental hazards across Wales continue to pose health risks for individuals and communities. Chemical contamination of air, water and land caused most public health concern.
The CMO makes five recommendations relating to public health protection.
Article by Rebekah James, Senedd Research, National Assembly for Wales
