Vision for future of NHS and social care in Wales revealed
AVISION for the future of health and social care in Wales has been outlined by the Welsh Government, with an emphasis on bringing care closer to people’s homes and reducing reliance on hospitals.
A landmark report, unveiled by Health Secretary Vaughan Gething, details how the NHS and social care in Wales can be sustainable when demand for its services has never been higher.
An ageing population, poor lifestyle choices and high public expectations are said to be putting an unrelenting strain on the health service, which cannot cope if current trends continue.
In the Welsh Government plan, entitled A Healthier Wales, calls are made for more joined-up services to be provided in communities so those who truly need hospital care are seen more quickly.
It wants the health service to place a greater emphasis on preventing illness, on supporting people to manage their own health and wellbeing and on enabling people to live independently for as long as they can.
It builds on the philosophy of “prudent healthcare” which focuses on
caring for those with the greatest health need first and doing “only what is needed, and no more”.
A £100m Transformation Fund has been created by the Welsh Government to support the plan’s implementation.
This cash will be targeted at speeding up the process, including the development of new integrated prevention services and activities in the community.
Mr Gething said: “With an increase in life expectancy and our continued public health challenges the service is facing increasing pressure.
“Today’s plan sets out our vision for the future – it looks at how we will adapt to meet these future challenges and transform the way we deliver health and social care.
“We will deliver that change and remain true to the core values of the NHS to provide free healthcare for all.”
This is the first time the Welsh Government has set out a shared plan for health and social care.
The aim is to see a shift from healthcare which focuses on treating people when they become unwell, to one that provides services which support people to stay well and lead healthier lifestyles.
There will also be more focus on “seamless services” and holistic care which are designed to fit around the individual.
The plan also commits the Welsh Government to increasing investment in digital technologies and to support and develop the workforce, including unpaid carers and volunteers.
The report follows a major Parliamentary Review into health and social care, chaired by the former chief medical officer for Wales Dr Ruth Hussey, which concluded that a “revolution” was needed in the way health and social care is delivered in Wales.
Mr Gething added: “Today we are responding to that review. This will be a revolution from within the health service.
“We have to move on from the idea that the hospital is the first or best place for you to be when you are unwell. That isn’t always the case, especially when there are a range of local services that will allow you to remain safely at home.
“I recognise the challenge and this will take time, but change will begin immediately.
“By the time we celebrate the 80th anniversary [in 2028] of our NHS, I expect to see a stronger, joined-up sys-
tem between health and social care that will be fit to serve people for generations to come.”
Currently more than £9bn is spent on health and social services annually in Wales – 8% more per head of population than is spent in England.
And over the next two years the Welsh Government has committed to investing a further £450m in the NHS and over £100m in social care.
But latest figures show that health boards recorded a £163m deficit in the past financial year alone, with four of them under some form of Welsh Government monitoring or intervention.
The report states: “Achieving a sustainable funding model for health and social care that will stand the test of time will not be a quick task to complete, and discussions to find the right approach will potentially continue beyond the lifetime of this current Assembly.
“Through this plan we will make an urgent start on that work, by commissioning a new analysis of current spending in health and social care, and how adoption of new models of care can impact on the future costs.
“We will also start a national conversation to explore more radical options for funding social care in future, including how Wales’ new tax-raising powers could be used to provide a renewed promise.”
It is widely recognised that the health service is facing major recruitment and retention issues including in general practice and district nursing.
While recruitment campaigns, such as Train, Work Live, has proved to be a success, the Welsh Government admits there continues to be “fragility” in specific services.
As part of its long-term plan, the Welsh Government will commission Health Education and Improvement Wales (HEIW) and Social Care Wales (SCW) to develop a workforce strategy in partnership with NHS and Local Government, the voluntary and independent sectors as well as regulators, professional bodies, and education providers.
The British Medical Association has “cautiously welcomed” the longterm plan, but called on the Welsh Government and health boards to work with doctors and other frontline staff on the details to make the plan a reality.
Dr David Bailey, chairman of the BMA’s Welsh council, said: “This plan shows that the Welsh Government is moving in the right direction and taking steps to ensure that health and social services in Wales are sustainable in the future.
“We implore health boards to work with clinicians and frontline staff to understand how best to use the £100m Transformation Fund to improve the delivery of services and expect that doctors are able to use the ‘offer of involvement’ to improve local services.
“We hope that the money allocated to the fund will be matched by longer term investment.”
He added that moving resources into the community was something he also welcomed.
“BMA Cymru Wales also welcomes the move towards measuring the health and wellbeing outcomes which matter to people. This is something we have consistently called for and look forward to seeing more detail,” he added.
“Ultimately, actions speak louder than words and the onus is now on the Welsh Government and health boards to work with doctors and other frontline staff on the details to make this plan a reality.
“It is what the public and those who work in our NHS deserve.”
Similarly, the Royal College of GPs in Wales has called for the “warm words to be backed up with actions” and said the key test will be whether it delivers tangible improvements.
Dr Rebecca Payne, RCGP Wales chairwoman, said: “Broadly speaking, RCGP Wales welcomes the content of this plan.
“The references to workforce wellbeing are particularly welcome. Staff are working in very difficult circumstances and the NHS will only be as strong as the people in it.
“We note that the language used throughout, such as the continued focus on preventative care and care closer to home, will only be achieved if general practice thrives.
“The key thing now is making sure this document leads to tangible improvements in patient care; warm words need to be backed up with actions.
“General practice remains significantly under-resourced and this plan needs to be a catalyst for change.”
Tim Havard, director for Wales at the Royal College of Surgeons, said the announcement should help patients to avoid unnecessary trips to hospital.
“Providing more care in the community should offer some relief to busy hospitals by freeing up beds and staff so that those patients with the most serious illnesses can receive treatment more quickly.
“Waiting times for some types of treatment remain too high in Wales. As the Welsh Government’s plans for health and social care take root, we hope there will be an opportunity to focus on improving timely access to hospital services for Wales’ sickest patients alongside necessary improvements to primary and community care.”
AS PEOPLE live longer, the cost of providing them with the health and social care they need grows inexorably.
The NHS is taking more and more of the Welsh Government’s budget, but it is politically unacceptable to even consider charging patients for core health treatment.
That largely explains the content of the Welsh Government’s new vision for the future of health and social care.
It costs far less to treat patients at home – or at a GP surgery – than in hospital. It’s no surprise, therefore, that the vision involves less patients going to hospital. That’s fine in principle, but with the exception of individuals who end up in A&E units after drinking too much, patients do not refer themselves to hospital. They are sent there because their GP thinks they need to go, or in a genuine emergency. It would be unacceptable for patients in genuine need of hospital treatment to be denied it because of financial concerns.
Nevertheless, it’s likely that some procedures that currently necessitate a hospital appointment could be dealt with more efficiently in the community.
The big conundrum relates to the funding of social care: providing services in patients’ homes that enable hospital beds to be released for others. Delayed transfers of care continue to cause problems for the NHS in Wales. Many patients cannot be discharged from hospital because adequate care plans are not in place for them in the community. There is clearly a need to beef up such provision, but that would cost money.
While the Welsh Government is providing £100m for a “transformation fund”, it is floating the idea of introducing a social care levy. Such a proposal, says the report which outlines the new vision, should form part of a “national conversation”. If Health Secretary Vaughan Gething is serious about introducing a levy – and at this stage he is just floating it as a possibility – we can expect a formal public consultation in due course. Such a proposal would be controversial, as Mr Gething will realise. The suggestion of a “dementia tax” during last year’s General Election was one of the reasons why the Conservatives lost their overall majority.
Integrating health and social care has been an aspiration held by Welsh politicians since the National Assembly was established. So far, there’s been a lot of talk, a considerable amount of grandstanding, but little actual delivery. It’s time for that to change.