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Health

Committee calls for prescription drug guidance

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TACKLING prescription drug dependence should be given a higher priority in Wales according to the National Assembly’s Petitions Committee.

The Committee concluded there is growing recognition of the issues surrounding prescription drug dependence (PDD) among clinicians and organisations, but there is no Welsh Government strategy aimed at addressing them and few targeted services. As a result, patients are often referred to substance misuse services which may not be well-suited to providing the support they need.

The Committee report stems from a petition started by Stevie Lewis from Monmouth, which collected more than 200 signatures. Ms Lewis told the Committee: “My name is Stevie Lewis and in 1996, at the age of 41, I was prescribed an SSRI (Selective Serotonin Re-uptake Inhibitor) antidepressant for intermittent insomnia and PMT.

“In 2002, after several attempts at stopping and failing, I discovered that I had become physically dependent on the drug. For years I kept trying to come off the drug and each time the withdrawal symptoms got worse and worse.

“In 2009 I developed a movement disorder which has its roots in long term use of an SSRI antidepressant. Eventually, I stopped in 2013 and have been through a long and crippling withdrawal.”

Ms Lewis highlighted both antidepressants and benzodiazepines (sedatives) as among the medications which can cause PDD, with patients potentially experiencing difficulties coming off them due to side effects.

The Committee also received concerns that:
• There is a high volume of prescribing of these medications across Wales;
• There is a lack of alternative services available for people with depression, leading to an overreliance on medication;
• Current advice on how to withdraw from antidepressants is insufficient and underestimates the challenges related to coming off these medications; and,
• Not enough use is made of professionals such as pharmacists who could give advice to patients.

“The Committee received a range of concerning evidence about the impact that attempting to stop a range of prescription medication can have on individual patients,” said Janet Finch-Saunders AM, Chair of the Petitions Committee.

“Antidepressants and other prescription medications can be a lifeline to many people. However, there is a growing body of opinion that it can be difficult to stop using some medications and that not enough advice is available to patients at the outset.

“What is clear is that we need to do more to improve the support and information that is available to people who are prescribed these medications.

“The Committee received evidence demonstrating that good services exist in parts of Wales, and we feel that these should be replicated much more widely.

“The personal experiences we have heard during this inquiry have been, at times, deeply upsetting and we thank the petitioner for having the courage and strength to bring this to our attention.”

Petitioner, Stevie Lewis, said: “The Welsh public petitions process has turned out to be truly democratic and empowering. All those who provided evidence to my petition were listened to with attention and respect.

“The committee has taken seriously my contention that we need to be able to hold as true two apparently conflicting beliefs about antidepressants at the same time, namely that they can help people and also that they can harm people. And once a patient has been harmed by any drug that causes dependence and withdrawal, there are no nationwide NHS services in place to guide and support their recovery. I look forward to hearing the Welsh Government debate this issue in the Senedd.”

The Committee makes 10 recommendations, including:
• Greater recognition should be given to prescription drug dependence in national policy and strategy, and this should be distinguished from substance misuse services.
• The Welsh Government should restate and emphasise antidepressants should not be routinely prescribed for mild depression in guidance to healthcare professionals, and should provide assurances that sufficient alternative treatment options, such as psychological therapies, are available across Wales.
• Additional guidance is produced and promoted in relation to the safe tapering of prescription medications, both for patients and healthprofessionals.

The report will now be considered by the Welsh Government.

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Health

Dental services ‘facing collapse’ in Wales

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DENTAL services are at risk of catastrophic collapse, with people resorting to “DIY dentistry” and pulling their own teeth with pliers, the Senedd heard.

Peter Fox warned that NHS dental services are seeing rapid decline following the Welsh Government’s introduction of a new contract in 2022.

He told the Senedd: “These contracts don’t work for dentists, nor do they work for patients,” as he highlighted a 60% fall in the number of NHS dental posts compared with 2021.

Echoing concerns raised by the British Dental Association, the Conservative MS said dental services face potential catastrophic collapse due to the contract reforms.

Mr Fox, who represents Monmouth, cautioned that patients are being left with a choice between years’-long waiting lists or paying hundreds of pounds for private care.

He said: “This lack of accessibility has led people to drastic action – from harrowing stories of people pulling out their own teeth with pliers or people being forced to take 200-mile round trips to get dental appointments. Clearly, this is just simply unacceptable in the 21st century.”

Leading a debate about primary care on April 24, Mr Fox warned GPs are also struggling due to a lack of contract funding, which is not uplifted in line with rising costs and pay uplifts.

He told MSs some GPs are having to pay staff and utility bills out of their own pockets, with practices forced to withdraw more and more services.

The Conservative said some constituents face 50-mile round trips and 50-week waits for services in hospitals that were previously carried out routinely and timely in GP practices.

Mr Fox, who led Monmouthshire council for more than a decade before being elected to the Senedd in 2021, urged the Welsh Government to urgently review GP and dental contracts.

Eluned Morgan told the chamber the majority of contacts with the NHS are in primary care – with up to one-and-a-half million contacts a month in a population of three million people.

Wales’ health secretary recognised the extreme pressure on practices, saying the contract last year provided a 5% uplift not just to GPs but also staff who work in their surgeries.

She said: “We want to reform the dental contract on a preventative basis, responding to risk and need, and we have introduced up to 300,000 appointments to new dental patients.”

Baroness Morgan, who is married to a GP, stressed the importance of other professionals in the community, such as pharmacists and opticians, to the preventative agenda.

She said most pharmacies in Wales provide a free service for 27 common ailments, helping to reduce pressure on GPs and other parts of the healthcare system.

During first minister’s questions on April 23, Sian Gwenllian said many of her constituents are unable to access public dental services – “an entirely unacceptable situation”.

The Plaid Cymru MS for Arfon raised concerns a new dental academy in Bangor closed its books to NHS patients despite promises it would help tackle a lack of public services.

Sam Rowlands, the Conservatives’ new shadow health secretary, said far too many people across north Wales do not have access to an NHS dentist.

He raised comments from Russell Gidney, chair of the Welsh general dental practice committee, warning of a rise in “DIY dentistry” due to a lack of proper access.

Vaughan Gething said the Welsh Government is committed to reforming the dental contract to unlock capacity and access to NHS services is one of the health secretary’s top priorities.

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Health

Pembrokeshire residents suffer severe health decline ‘due to landfill gases’

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A PEMBROKESHIRE couple, Mr Richard and Revd Patricia Rogers of Crud yr Awel, are experiencing severe health issues attributed to emissions from the Withyhedge Landfill, resulting in drastic lifestyle changes and severe symptoms.

Revd Rogers, who has managed asthma since childhood, reported a significant deterioration in her condition following exposure to landfill gases. Despite having controlled her asthma with minimal medication for years, she now requires intensive treatment including increased doses of Symbicort and Salbutamol Sulfate inhalers, alongside courses of steroids and antibiotics. Her symptoms have escalated to include extreme breathlessness, a hacking cough, frequent nosebleeds, continual headaches, and vertigo, culminating in a severe impact on her ability to perform daily tasks and care for her disabled daughter.

The couple’s health is closely monitored through their doctor’s surgery, and they attend the asthma clinic regularly. However, feeling powerless to directly change the situation, they have taken a stand by cancelling their council tax payments, a decision they plan to maintain until the landfill issue is resolved.

Revd Rogers has also prepared a letter to the Coroner, outlining the severity of her health issues as potentially life-threatening due to the landfill’s impact. This dramatic step underlines the gravity of their situation and their desperation for a resolution.

The Rogers’ story is not just a personal tragedy but a stark example of the broader environmental and health challenges faced by the community surrounding the Withyhedge Landfill.

They are calling for punitive measures against those responsible, including compensation for the financial impacts of their ordeal.

Their story has surfaced on the same day we reported that Natural Resources Wales is taking further enforcement action against the firm running the site.

NRW has issued site operators Resources Management UK Ltd (RML) with a further Regulation 36 Enforcement Notice which requires the operator to deliver a series of actions by specified deadlines to address ongoing smells from the landfill.

You can read more about the Enforcement Notice on the NRW website.

Outgoing Council Leader, Cllr David Simpson, said in a statement this week: “The smell from Withyhedge is having a major impact on residents and visitors. This situation has gone on too long and it is unacceptable.

“We now need to see RML act on the demands of the Notice and within the deadlines.

“The Council fully backs NRW’s stance that nothing is off the table in terms of further enforcement, including suspending the site’s environmental permit if appropriate, and we remain committed to working with NRW to ensure a long term solution to these issues.”

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Health

Paul Davies responds to St David’s Surgery news

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LOCAL Senedd Member Paul Davies has reacted to the news that St David’s surgery in North Pembrokeshire has decided to resign its General Medical Services Contract. It’s understood that for registered patients, care will continue to be provided until the end of October 2024 and patients are being advised to remain registered with the Practice while longer-term plans are developed. Patients will be invited to share their views as to how these services can continue to be delivered after the end of October.

Mr Davies said, “This is a very worrying announcement and patients in the local area will be understandably anxious about what this means for the future.”

“It’s vital that GP services can continue to be delivered in the area in the future and so Hywel Dda University Health Board must be open with patients of the Practice about their plans and address the community’s concerns. Every effort must be made to ensure that patients are able to access services in the long term.”

“I will of course, be raising this with the Welsh Government and urging the Health Minister to do everything in her power to support the Health Board and help ensure patients can access these vital services.”

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