THE STATE OF THE WELSH NHS AS TOLD BY ITS STAFF AND THE PATIENTS THEY TREAT
DOCTORS, nurses and patients have spoken about their experiences of the Welsh NHS as it endures one of the toughest winters in living memory.
The world-renowned service, which turns 70 this year, has been described as “bursting at the seams” as it struggles to cope with an everincreasing demand.
A severe outbreak of flu – the worst since 2010-11 – the winter vomiting bug and an increase in ill elderly patients have put a strain on all areas of healthcare.
We interviewed staff and patients across the entire system – from GPs to hospitals to social care – to find out how they are coping and what can be done to alleviate the pressure.
Accident and Emergency The Royal College of Emergency Medicine has described A&Es as like “battlefields” and dozens of A&E doctors have now written to First Minister Carwyn Jones, Health Secretary Vaughan Gething, inset, and Prime Minister Theresa May to highlight the scale of the problem.
At the University Hospital of Wales (UHW) in Cardiff, experienced A&E staff described this winter period as one of the busiest on record. More than 140,000 people have attended in the past year alone.
During our visit to the unit on January 12, the department was a hive of activity, with high numbers of patients in waiting areas and some being wheeled on trolleys in and out of bays every few minutes.
Leanne Harrington, from Barry, and her partner Gary Angel visited UHW’s A&E department when Leanne had a severe flare-up of colitis.
Gary said: “Leanne was admitted to the hospital as an emergency patient.
“After more than two hours she was seen by a nurse just to take details, then had to wait a further two hours to see a doctor.
“He told us she might have to stay the night, sitting in a chair in the waiting room with other patients.
“She was in agony. There was no communication from nurses or doctors at all.”
He said many other patients – with more serious conditions – also spent many hours sitting in the hospital’s assessment ward.
“There was a woman sitting with us who’d suffered a heart attack. We also saw a man who’d nearly lost his hand who was sitting there with his arm above his head for hours and hours.
“In the end Leanne spent 17 hours in the chair waiting to be seen. We shouldn’t have been treated like that.
“There are not enough beds in the hospital and the whole experience was terrible.”
In the unit’s major injuries area, the vast majority of patients were frail and elderly, some with obvious respiratory problems judging by their very audible coughs and splutters.
Ffion Lloyd, a staff nurse at the department, said this winter had been one of the busiest in her six years working in A&E.
“We’re a good team for keeping morale high. We all pull together when we need to,” she said.
“Even when we’re all feeling it at the end of a 12-and-a-half-hour shift, we’re all really good at helping each other out if someone is having a particularly tough day. It’s a fab team, it’s like a second family here.”
Despite her cheery disposition, Ffion said the past few weeks have taken their toll on her – both physically and mentally.
“Since the turn of the year we’ve been extremely busy. I have been here six years and it’s been one of the busiest winters on record,” she said.
“We are very short-staffed due to sickness because there’s been a lot of flu going around.”
One of Ffion’s seniors, Sharon O’Brien, lead nurse for emergency and acute medicine at UHW, said the hospital has experienced many challenging days since the turn of the year.
But she said the department has never resembled a “battlefield”, as the Royal College of Emergency Medicine recently suggested.
One of most visual signs of high demand at UHW is when scores of ambulances are queuing outside A&E unable to hand over patients into a full unit.
“We fully appreciate that it can be frustrating for the Welsh Ambulance Service and paramedics if they are not able to bring their patients into A&E as quickly as they would like,” Sharon said.
“We strive to be able to bring patients in to deliver the highest standards of care. We have an excellent relationship with the service. We have a majors assessment nurse on the front door who ensures they are constantly linking in with the ambulance service to ensure if a patient needs to come in as a priority we will bring them in. “Our ultimate aim is to get every patient in within 15 minutes of arrival.”
At the Royal Glamorgan Hospital, near Llantrisant, the decision has been made to transfer all patients straight into A&E as soon as they arrive.
Ruth Alcolado, a consultant physician and deputy medical director for Cwm Taf University Health Board, said more patients are seen in A&E waiting rooms on trolleys than in other similar depart- ments across the country.
She said: “It means that we can assess our patients so crews can get on doing their job, but what it also means for our nursing staff is that we have more patients in the department.
“We feel that’s still the safest decision, but for the nursing staff that’s a lot of work because they have more patients to look after.
“We would have more patients on trolleys at this time of year than we would in other times of the year.
“We now have new facilities which keep our minors stream going even though we have more majors patients coming in.
“It means we have overflow areas we can expand into as numbers go up, which means we have got six additional trolleys with bed-type mattresses so they are suitable for patients to stay on if necessary, and we would put additional nursing staff into those areas to manage the increased numbers.”
She said the two accident and emergency departments in Cwm Taf UHB saw a 10% increase in activity and attendances over the festive period compared with the same time 12 months earlier.
She added: “Our staff are extremely professional and have to manage patient tensions all the time.
“Most people who come in are not
worried because they’ve had to wait a long time, they’re worried because they’re sick or looking after their relative who’s sick and understandably tensions run high, but our staff are extremely good at managing those sorts of situations.”
General Practice
A huge spike in viral infections, such as the flu, has substantially increased the number of patients visiting their GP surgery in recent weeks.
As a result, patients have complained about not being able to get an appointment quickly.
Dr Will Mackintosh, a GP in St Clears, Carmarthenshire, said: “We’re seeing greater numbers of patients attending surgeries and this can lead to considerable pressure to offer timely appointments.
“We tend to see more people with respiratory symptoms, such as coughs, usually caused by self-limiting viral infections.
“We also find that the most frail patients, who often require visits at home, can become unwell at this time of year and this increases the pressure on time of GPs and their teams.”
Dr Rebecca Payne, chair of the Royal College of General Practitioners in Wales, said: “Will’s experience is replicated in practices across Wales. Winter pressures are inevitable, and following the bad flu season in the southern hemisphere the extra pressures this year were expected.”
RCGP Wales has called for an increase to 200 GP training places a year in a bid to boost GP numbers.
Dr Payne added: “We want all foundation doctors to have exposure to general practice and we want an increase in the percentage of Welshdomiciled students accepted to study medicine in Welsh universities.
“It needs to be easier for practices and hospitals to work together. We also need more investment in the sector – in 2015-16 Wales received the lowest NHS budget share of any UK nation.”
Discharging patients from hospital
Health professionals say one of the most difficult problems facing the entire NHS system – and the welfare of patients – is delayed transfers of care.
This failure to move patients through the system slows down their transfer from A&E to the wards, which in turn leads to ambulances stacking up outside.
For patients it can mean a loss of mobility and independence – and the risk of acquiring new infections.
But initiatives are being put in place to ensure patients who are suitable to return home are being discharged as soon as possible.
The Stay Well @Home team is funded by the Welsh Government’s intermediate care fund and is a joint partnership between Cwm Taf University Health Board and local authorities in Rhondda Cynon Taff and Merthyr Tydfil.
Emma Ralph, manager of the Stay Well @Home team, said the team aimed to get patients sent home with a package of care within four hours.
She said: “The team works seven days a week, 365 days a year. We are on site between 8am and 8pm and the team covers virtually every area of the hospital, but the primary function of the team is to avoid unnecessary hospital admissions by assessing people earlier in their A&E journey.
“We rely heavily on our medical and nursing colleagues to work with us to highlight those potential people who might have difficulties if they need to return home as a result of an acute illness or injury which means they’ll need more support.”
She said many elderly and frail patients are initially hesitant to take on their advice when they first attend A&E.
Social care
Hold-ups with paperwork on the part of the NHS and local authorities are stopping elderly people being discharged quickly from hospitals into care homes.
That’s according some care home managers in Wales who claim delays in the preparation of formal care assessments of patients can often leave them blocking vital hospital beds.
Clive Nadin, registered manager and owner of the independent care home Abbey Dale House, said: “Nursing beds in the Conwy county area are in very short supply due to recent home closures. In fact, we’ve lost nearly a third of our dementia nursing beds in just the past year.
“The problem is that it can take quite a long time to transfer people out of hospital and into homes like ours because of hold-ups with the paperwork.
“It’s becoming a major headache. I recently had a case where I went into a local hospital to do my side of the assessment of a patient on a Friday but the person wasn’t eventually transferred until the following Tuesday.”
Mr Nadin said another problem facing the care sector at the moment was the wave of flu cases sweeping the country.
Mr Nadin said that staff morale was becoming a factor at care homes across Wales.
He said: “The amount of money we get from the Welsh Government via local authorities and the health board to run the homes means we are not able to pay our staff as much as the NHS.
“Although they do an extremely hard job, we can only pay them £7.50 an hour, which is £1 an hour less than they’d get working in the health service. It’s a dual standard, really.”
So what does the future hold?
A leading think-tank warned in 2016 that the Welsh NHS needs to deliver at least £700m of efficiency savings by 2019-20.
The Health Foundation carried out an independent study and found that NHS spending would need to rise by 3.2% a year to keep pace with the growing demand on services.
It has predicted that maintaining the current range and quality of services would see spending rise from £6.5bn in 2015-16 to £10.4bn in 2030-31.
The Welsh Government allocates almost half of its overall budget to healthcare, but many health boards are still failing to stay within their financial means.