Speech from the Chairman of the Welsh Council
Dr Tony Calland
Wednesday 30 June 2004
The NHS in Wales
This week has seen the NHS become once again a political battlefield.
Politicians should realise that the public are no longer impressed by claims that are manifestly at variance with their experience of the service and by new ideas which will suddenly and magically solve the longstanding problems of inadequate capacity, postcode treatment and long waiting lists.
It is a credit to all the staff of the NHS in Wales that once the patient has actually arrived in the correct part of the service then the treatment they receive is usually of the highest quality . Patients requiring emergency treatment access very highly skilled services rapidly and these are delivered with skill and compassion. Ironically it is this very emergency service that creates much of the problem. NHS Wales is so overwhelmed with emergency cases that theatre time, diagnostics, ITU access and clinicians time gets diverted away from the patients requiring elective procedures causing cancelled operations, cancelled outpatient clinics and general frustration all round.
For general practitioners there are similar frustrations; there is difficulty in getting rapid advice about patients from specialists who are already working at 110% capacity, and there is difficulty getting access to sophisticated diagnostics such as MRI scans and very long waits to get patients into the out patient department often increases demand for primary care appointments so GPs may expedite hospital appointments.
In 2003 the Welsh Assembly government asked Derek Wanless to report on the state of the NHS in Wales. His report stated that the current NHS Wales was unsustainable for the medium term and that substantial changes should be made. This report, followed by a very critical report from the Audit Office, has generated very substantial activity in the WAG. The magic buzz word in Cathays Park is “Wanless” ! This report seems to have turned into a whole philosophy in itself, almost as if solutions to the problems will suddenly appear if the “Wanless” word is chanted with sufficient commitment and belief for long enough.
Sadly for those at the front line, both in general practice and hospitals, very little has changed and there seems to be very little clear jargon free policy direction coming along to give those who are struggling in the service some hope.
This has a knock on effect on moral and therefore recruitment and retention . Wales has enough difficulty already in attracting high quality staff to work in the more far flung parts of the Principality. The magnetic effect of border Foundation hospitals in England with their ability to pay above and outside normal pay rates may make it even more difficult to recruit to a Welsh service stretched to the limit.
So enough of the problems, what of the solutions ?
There needs to be a centrally driven plan which has been agreed with the front line stakeholders. Groups such as the BMA, Academy of Royal Colleges, RCN and Royal Pharmaceutical Society to represent professional views, the NHS Confederation to represent management views and Community Health Councils to represent patients views are all essential to this agreement if the plan is to succeed.
LHBs and Regional offices need to improve their detailed commissioning, using practice level referral data and do more work on referral patterns and the reasons for referral . Much work has been done in England and this should be transposed to Wales.
Emergency admissions need to be managed more effectively and again much work has been done in England to allow more effective direction of patients to receive appropriate care.
Welsh hospitals need to provide a range of services which are better integrated with those of neighbouring hospitals. Such reconfiguration will reduce service provision being duplicated within a close geographical area and also reduce bureaucracy in the system. It will also ensure a more efficient use of the very scarce diagnostic resources to help to alleviate one of the “pinch points “ in the system.
At present the hospitals are functioning almost in isolation from one another increasing duplication and reducing the critical mass of specialist cases so important to keep the skills of specialist clinicians at maximum levels.
The LHBs are the critical organisations in this jigsaw but they have minimal resources and certainly a very small pool of experienced commissioners to enable them to work efficiently . Too often, for many reasons, their commissioning actually means continuing with what is already happening rather that coordinating an agreed plan to reconfigure services using a mixture of primary care, secondary care and the social sector .
The anticipated integrated working with LHBs and the Unitary Authorities has not happened across Wales, only being effective when driven locally by innovative thinking and like minded individuals.
The Health Secretary, Jane Hutt, has received much criticism for this depressing state of affairs. So far the BMA has been supportive of the WAG and Ms Hutt as the difficulties in running such a service are complex and numerous.
However the BMA is losing patience with the lack of strategic direction and planning and is putting the Assembly on notice that our support in the future will become more dependent on results and improvement in the service to patients.
Patients in hospital need better personal care, the vulnerable being fed, having wet beds changed rapidly and the ward toilets being clean and functioning properly. These are seemingly small points but they mean a huge amount to frightened and infirm patients and far more than “apparent” reductions in the waiting list .
The Wanless report was full of common sense and ideas for the long term. NHS Wales needs improvement NOW so the WAG needs to start a major exercise in strategic planning with the stakeholders NOW.
The patients of Wales deserve this from their government and their Assembly.
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