The NHS is Wales is in crisis - how can we fix it?

Over the Christmas week, ambulance staff spent the equivalent of just over 311 days waiting outside hospitals to admit patients across Wales, while it is estimated there are around 1,700 patients in Welsh hospitals who are ready to be discharged, but cannot be due to the lack of social care availability.

There is also discontent among staff over pay, conditions and patient safety, with RCN nurses striking for the first time in history across England, Wales and Northern Ireland, and ambulance staff from several unions also taking industrial action.

Darren Hughes, director of the Welsh NHS Confederation, told BBC Radio Wales the health service was “on a knife edge”, and had been “tipped over the edge” over Christmas.

“It’s really harming staff who aren't able to provide care to patients at the level that they would want to,” he warned.

We’ve taken a look at three areas of concern for the Welsh healthcare system, and some of the solutions which could help address the current crisis.

Funding the health service

In order to address the crisis in the health service which has left staff concerned over patient safety, Mr Hughes called for a “long term funding commitment”.

“The NHS has been under pressure and underfunded for a significant period of time,” he said. “We've got a political blame game happening between Cardiff and Westminster.

“We need a long-term funding commitment so we could develop the workforce.

Darren Hughes called for a long-term funding commitment for health and social care. (Image: Other)

“We hear talk about beds; it’s about much more than beds. This is about having the staff that we need to look after the people of Wales and the rest of the UK, which we simply don't have at the moment.

“You can't train people in weeks or months, this takes years. We need clarity now to train the nursing workforce that we need.”

Peredur Owen Griffiths, South Wales East MS for Plaid Cymru, said the Welsh Government should “use all the levers at their disposal” to support staff in the health service.

“The NHS in Wales is in crisis – to claim otherwise is to do a great disservice to the many hard-working health and care staff that are telling us otherwise,” he said.

Peredur Owen Griffiths said the Welsh Government should act to support healthcare workers.

“When there is too much work for too few people, it is inevitable that service levels will start to wildly vary around the nation, and what I’m hearing from constituents is that there is a postcode lottery in our health service at the moment.

“The strikes from our health workers have never just been about pay. Our health and care staff are over-worked and under-resourced and have lost faith in the Welsh Government’s ability to manage the NHS. These strikes are the last resort of a health service on its knees.

“It is not good enough for Welsh Government to lay the blame on UK Government – while it’s true that Westminster holds the purse strings, Welsh Government is not powerless to act.

“Welsh Government must use all the levers at their disposal to improve the pay award and to improve working conditions. Without workers, there is no NHS.”

Welsh secretary David TC Davies stressed the current healthcare crisis was not a criticism of individual doctors, nurses and ambulance staff.

“Large numbers of constituents have been in touch to complain about the level of NHS care which they have been getting,” he said.

David TC Davies called for an independent inquiry into how healthcare is delivered in Gwent. (Image: Supplied)

“In particular there are problems with ambulance response times, the length of waits at The Grange, and the length of time people are waiting for routine operations.

“Nobody is criticising individual doctors, nurses and ambulance staff. People are very clear that the individuals they meet are caring and helpful. The problem is within the system itself. 

“I have suggested that we need some form of independent inquiry to find out what is going wrong with healthcare in Gwent but the health minister appears to be unwilling to even accept that there is a problem.”

With health being a devolved matter, Mr Davies added that the Welsh Government “need to accept that there is a problem” and “only they can solve the problem” currently, not the UK Government.

Addressing ambulance delays and patient flow issues

Darren Panniers, head of service in the South East for the Welsh Ambulance Service, told the Argus more than 30 per cent of ambulance clinicians were waiting outside hospitals to hand over patients at any one time.

“Extended handover severely hampers the organisation’s ability to respond to patients in the community,” he said.

“Estimates suggest that there are some 1,700 patients in hospitals across Wales who are medically fit for discharge, however, unable to be discharged until appropriate support is in place at home or within a community setting.

“This means fewer beds for admissions, longer waits outside hospitals for our patients and clinicians, resulting in fewer ambulances available to respond to our communities.

“This is not the level of service we want to provide patients across Wales and as an organisation we are working hard to improve our response as a matter of urgency.”

Ambulances outside the Grange University Hospital.

The Welsh Government said a “national improvement plan” was in place to “increase ambulance staff numbers” and “improve response times and reduce patient handover delays”.

“To help improving the flow of patients through the hospital system, we have asked health boards to focus on safely discharging people who no longer require treatment in hospital,” a spokesperson said.

As part of this, it has been reported that the Welsh Government has told NHS managers that, due to the current “unprecedented” demand on hospitals, patients could be discharged from hospital, even if they did not have arrangements for care at home in place.

The social care sector has criticised the move, saying it will leave carers and family members unprepared to look after patients and could lead to avoidable re-admissions.

“It’s absolutely vital for a patient who needs support after leaving hospital to have a care package when they are discharged,” said Mary Wimbury, chief executive of Care Forum Wales.

“In many cases, vulnerable people can’t support themselves in doing the every day activities of living – and we can’t be in a position where we are effectively leaving them to fend for themselves.

“We’ve got to provide that care but we’ve also got to provide that support to care workers who are able to provide that care.”

Chief executive of Care Forum Wales Mary Wimbury. (Image: Care Forum Wales)

Age Cymru chief executive Victoria Lloyd agreed. “We are extremely worried that without the right care and support people are at risk of deterioration and re-admission which benefits no one, least of all the patient,” she said

“We are also very concerned about the impact on unpaid carers who will have to care for a loved one without appropriate support or planning, which could push them to breaking point and adversely affect their own health.

“This could ultimately lead to what could have been an unavoidable readmission to hospital.”

Social care funding

In December, the Welsh Government announced 508 ‘step down’ beds and community care packages which had been agreed with local authorities and health boards, as well as £70 million funding to ensure social care workers receive the real living wage.

However, rising costs have led many councils across Wales to propose cuts to social care funding in the next financial year.

Newport council’s draft budget proposes cutting staffing in children’s and adult social care, closing the Cwtch Centre – which is used for children in the care of the local authority involved in public law proceedings, and limiting the number of new residential placements in residential and nursing care.

Cllr Jane Mudd, leader of Newport City Council. (Image: NQ)

Leader of the council, Cllr Jane Mudd, said balancing the cuts needed and the demand on services had been “an extremely difficult process”, adding “the sums simply don’t add up”.

“Two thirds of the council’s budget is spent on schools, education and social care – the absolutely essential services, where savings are very difficult to make,” she said.

“But I want to reassure everyone that the challenges being faced by residents, businesses and individuals will always be at the forefront of the council’s considerations.”

• READ MORE: Should council tax go up by 9.5% in Newport? How you can have your say.

Cllr Mudd said several factors were behind the need for such extensive cuts, “including the failure to provide Wales with a fair funding settlement and the ending of energy support by the UK Government”.

“The health and social care issues must be addressed nationally,” added a Newport council spokesperson.

“The ongoing challenges across health services and workforce issues within social care is a priority for the council.”

However Ms Wimbury said the fees health boards and local authorities paid providers didn’t allow them to pay care home and domiciliary care workers well enough.

“What we have to do is to make the system work together with health boards and local authorities recognising that their own attitudes in terms of how they commission care and how they pay for it is causing the crisis in social care,” she said.

“We have to be more joined up in terms of paying appropriate rates to enable providers to pay staff sufficiently to retain and recruit them, and provide the support that people need.

“It’s a lot cheaper to care for people in their own homes and in care homes than it is in hospitals, so we can free up money by investing properly in social care as well as keeping people out of hospital in the first place and getting them out more quickly when they’re there.

“We really need a national system and a national structure. Welsh Government have been saying we’ll get one but not before 2024. We need to have it sooner than that.

“Too many staff are still leaving social care. They’ve had a really hard couple of years with the pandemic and now there’s pressure on other parts of the system as well.”

Sanjiv Joshi said it would be disastrous to cut social care funding further. (Image: Care Forum Wales)

And Sanjiv Joshi, chairman of the Caron Group, which has care homes in Brynmawr and Caerphilly, warned against councils cutting social care budgets.

He said: “The pandemic and the current crisis in the NHS have brought into focus how dependent our communities are on the social care sector.

“We were relieved that the local authorities had started to address the historic shortfalls in funding but if they were to bow to pressure and reverse that process it will only compound the problems the NHS is struggling with.

“We are an ageing population. The social care sector has a vital part to play in helping the NHS and society through this crisis and in preventing a similar crisis in the future – it would be disastrous to reverse those increases in funding now.”

So what can be done?

What is clear from listening to those in the health and social care sector is that there is no quick fix to this current crisis, but things cannot carry on as they are. 

Work needs to be done to retain and attract new nurses, ambulance staff and carers to address patient safety concerns, while increasing social care capacity in the community is key to reducing ambulance and A&E waits.

What moves do you want to see taken to address the NHS crisis? Let us know at newsdesk@southwalesargus.co.uk