Doctor Badger Delivers Bad News
THE NEWS that BMA Cymru has suspended strike action will relieve Welsh ministers amid a blizzard of bad news about the Welsh NHS.
Accident and Emergency care is fragile.
Outpatient waiting times show no sign of ever reaching performance targets. Social care is a lottery. Staff shortages for clinical and care staff are chronic across Wales. Ambulance waiting times remain stubbornly long, especially in rural counties. Specialist treatment for those with the most serious eye conditions is in crisis.
Meanwhile, the Welsh Government says it wants more patients to remain in their homes and communities, supported by families and primary care staff. However, the cornerstone of primary care, general practice, is crumbling, if not collapsing. NHS dental care provision is risible. Mental health care is, at best, hit and miss.
In 2018, former Carmarthenshire County Councillor Carl Harris made an acid observation about changes to primary care provision in Cross Hands.
Hywel Dda UHB had “temporarily” suspended the provision of some primary services in Cross Hands and Tumble. Then-Cllr Harris suggested that, to the Health Board, “temporary” seemed an elastic term.
Full services were returned to Cross Hands and Tumble in March this year.
At least they were returned.
Pembrokeshire’s residents know only too well how meaningless “temporary” is when Hywel Dda UHB pulls the plug on services and claims an intent to return them. After stitchedup consultation after stitched-up consultation, Pembrokeshire knows that services are increasingly slashed, centralised, and inaccessible.
The cost of delivering care to sicker people living for longer has been shuffled from medical to social care, placing unbearable pressure on cash-strapped local authorities. Unlike health boards, councils must balance their budgets by law. The Welsh NHS, by contrast, is a money pit, swallowing resources and hungry for more.
During the Covid pandemic, then-health Minister Vaughan Gething wrote off health board debts. Only a short time later, health boards are buckling under crippling deficits that the Welsh Government insists they must bring under control. As with any service, the NHS has only one way of achieving that end: cuts, cuts, and more cuts.
“Transforming healthcare” means fewer specialist staff and a stampede to deliver the minimum care at the lowest possible cost.
The Labour Government in Cardiff Bay can try disguising or excusing its failure in any number of ways. It does. However, it is in charge.
Despite the mangrove thicket of Welsh NHS managerial and delivery structures and agonised pleas from successive Welsh health ministers that the NHS’s issues have nothing to do with them, responsibility for health policy and funding starts and stops at Cardiff Bay and has done since devolution and the First Assembly in 1999.
The Welsh NHS is not alone in its struggles.
Health and social care infrastructure is creaking and crumbling across the UK.
Let’s be clear about that. Whatever political points are scored against Labour in Wales can be scored just as easily against the SNP in Scotland and the Conservatives in England.
The NHS’s problem is not political; it’s practical.
A care system devised eighty years ago is unfit for modern life and clinical practice.
The NHS was a financial blackhole from the outset.
When the NHS was founded by St Nye the Blessed (Labour Party Bible, Nonsense Edition), it was rapidly overwhelmed by demand. The reason for that would have been readily apparent had any effort been made to examine the pre-existing tapestry of insurance and locallybased subscription healthcare.
The NHS’s founders forgot about women.
Although pre-NHS, women were less frequently presented to medical services for economic reasons, the demand for healthcare by women was underestimated or ignored. Overnight, millions of women across the UK suffering from long-term conditions and in need of dental care or optometry services gained access to universal health care free at the point of delivery.
The demand meant that, almost as soon as it began, the NHS was on the financial back foot.
The post-war baby boom from 1946 to 1963 put even greater strain on the system. More babies were delivered than ever before, and more babies and mothers survived birth due to better clinical treatment.
The inevitable outcome of improvements in healthcare meant the number of people living longer rose significantly. That also increased the demand for treatment.
Over the last fifty years, falling birth rates and rising life expectancies have compounded the financial problem by reducing the pool of taxpayers who fund the NHS and other public services.
Badger is saying that the NHS is not only in permacrisis but also incapable of meeting present and future service demands.
The NHS cannot endure in its current form or under its current funding arrangements.
Well, it could. However, it depends on taxpayers’ appetite to pay more for it through direct and indirect taxation.
The NHS is not “the envy of the world” or a good example of British exceptionalism. It is a lumbering, money-eating sacred cow.
Every one of us has an uplifting NHS story to tell. Politicians - especially Welsh Labour - relentlessly praise the institution when recounting their clinical experiences.
How many times have you heard a politician say words along the lines of: “If it wasn’t for the NHS, I wouldn’t be here today...” or, “I know the value of the NHS because it looked after [mum/dad/delete as applicable] when they were dying.”
Badger knows the value of the NHS to him. It keeps him alive despite his best efforts.
All of that anecdotage means absolutely nothing.
The cold and hard fact is that, as an institution, the NHS is shot.
It was never intended to be a national sickness service, but it is.
It cannot deliver the best care because it doesn’t have the staff it needs and will never have the staff it needs.
Its physical infrastructure is falling abroad and has not kept pace with evolving levels of care.
The need to cut costs and corners is driving unsafe changes in clinical practice.
The NHS needs radical change to survive in any form.
It cannot continue in its current one.
It’s time to let go of the myth and embrace reality.