‘Welsh NHS and so­cial care is a sham­bles and not fit for pur­pose’

Dr Iain Robert­son-Steel, who re­cently re­tired as the di­rec­tor of Withy­bush Hos­pi­tal, says new First Minister Mark Drake­ford has a ma­jor chal­lenge on his hands in turn­ing things around...

Western Mail - - WM2 -

THE NHS in Wales has re­cently passed its 70th an­niver­sary. There is no doubt that the NHS reached the point of near-cat­a­strophic fail­ure in win­ter 2017 with long delays for beds and un­ac­cept­able A&E wait­ing-times.

Win­ter 2018-19 is likely to be worse as pres­sure has been un­remit­ting since last win­ter.

Pa­tients were put at risk, hard­work­ing staff were driven to the point of near-ex­haus­tion and good­will was ex­ploited.

The NHS was un­der ex­treme pres­sure in win­ter 2017, with long delays in A&E, mass can­cel­la­tions of elec­tive op­er­a­tions re­sult­ing in wait­inglists grow­ing, and qual­ity of treat­ment de­clin­ing.

Mas­sive bud­get over­spends oc­curred due to a short­age of staff and the em­ploy­ment of locum doc­tors and agency nurses. The main­te­nance back­log of the ageing es­tate be­came even worse.

The in­crease in im­mi­gra­tion to the UK, 273,00 new res­i­dents ar­rived in 2017-8, with a fur­ther sim­i­lar in­crease in 2018-19, has put huge pres­sure on NHS re­sources and fund­ing, the ex­ist­ing ser­vices and hospi­tals, and GPs have to be spread in­creas­ingly thinly.

Dis­charges of frail el­derly pa­tients be­came vir­tu­ally im­pos­si­ble and read­mis­sions rates have in­creased.

Pa­tients be­came “stranded” in hos­pi­tal, block­ing beds at high cost and re­sult­ing in in­creased delays to dis­charge and front-door chaos. Un­funded ex­tra beds were cre­ated as emer­gency care spilled into elec­tive care.

So­cial ser­vice de­part­ments and staff con­versely did not meet the chal­lenge by work­ing longer hours or cre­at­ing ad­di­tional re­sources, there were no “four-hour tar­gets” in so­cial care and the NHS took the blame in the me­dia spot­light.

The blame game was played through­out the win­ter. Politi­cians buried their heads in the sand and re­sponded by send­ing “turn­around” teams to harry the hard-pressed NHS staff and at­tempt “trans­for­ma­tion” and threat­en­ing staff through “hold­ing-to-ac­count meet­ings”.

Sadly, Vaughan Gething and the First Minister were not sim­i­larly held to ac­count.

Sum­mer 2018 saw no re­lief from the pres­sures on A&E. Pri­mary care and the NHS bud­get con­tin­ued to slide and no real prac­ti­cal steps have been taken to make win­ter 20182019 any bet­ter than pre­vi­ous win­ters.

So­cial care de­mand and costs are ris­ing and the re­sponse by many coun­cils has been to blame the Welsh Gov­ern­ment for re­duc­ing their bud­get, and in turn the Welsh Labour Gov­ern­ment blames the Con­ser­va­tive UK gov­ern­ment for aus­ter­ity.

The blame cy­cle con­tin­ues and the “so­lu­tion” will sim­ply be to raise coun­cil taxes in Wales and gen­eral tax­a­tion yet again.

Coun­cil tax can­not be the source of fund­ing for health and so­cial care. Res­i­dents in Pem­brokeshire had a 12% in­crease in coun­cil tax in 2018-9 and there may be an even greater rise in 2019-20.

The bot­tom line is that the cur­rent Welsh Gov­ern­ment has been re­spon­si­ble for NHS and so­cial care in Wales for over a decade and a se­ries of min­is­ters have failed to ad­dress the core is­sues and de­velop fit-for-pur­pose ser­vices for the fu­ture.

Gov­ern­ment blames health boards for fail­ing to de­liver, when the problems faced by hard-pressed and much-crit­i­cised boards are be­yond their abil­ity to solve.

Un­less the Welsh Gov­ern­ment tack­les the fun­da­men­tal un­der­ly­ing problems of staffing, struc­ture, bud­get and “work­ing to­gether”, ser­vices will pro­gres­sively fail.

The fail­ure of the NHS and so­cial care will lie with the new First Minister and the gov­ern­ment team.

Fail­ure is, how­ever, not in­evitable. A new model of care can emerge which is sus­tain­able and af­ford­able. A new model must be fully costed and funded.

The Welsh Gov­ern­ment is great at pro­duc­ing new acts and glitzy ini­tia­tives but never costs them or pro­vides ad­e­quate fund­ing.

Firstly, the Welsh Gov­ern­ment needs to recog­nise and ad­dress the scale of the prob­lem. Wales is a small coun­try with a pop­u­la­tion of 3.2 mil­lion.

The state of the na­tion’s health is poor and the pop­u­la­tion is ageing. Wales is eco­nom­i­cally a poor per­former. UK gov­ern­ment sub­si­dies are de­creas­ing each year.

So­cial care is not work­ing in part­ner­ship with the NHS. The split cre­ated by Bev­eridge (1942) and Bevan (1948) and the found­ing fa­thers must change. A sin­gle Na­tional Health and Care Ser­vice (NHCS) should be put in place in or­der to make progress.

There should be a max­i­mum of five Health and Care Boards (South and West, South and East, North and Cen­tral, Emer­gency Am­bu­lance, and Spe­cial­ist Ser­vices) and the lo­cal au­thor­i­ties and so­cial ser­vices should be merged with health boards with a sin­gle man­age­ment team and a com­bined bud­get.

All of the struc­tural ac­tiv­i­ties of the lo­cal au­thor­i­ties – ed­u­ca­tion, roads and in­fra­struc­ture – should be put un­der a sin­gle ser­vice de­liv­ery or­gan­i­sa­tion de­liv­er­ing na­tional stan­dards of ser­vice with eq­uity.

Dras­tic re­duc­tions and real cost sav­ings in man­age­ment staffing and struc­tures could be made if the so­cial care func­tions and the bud­gets of the ex­ist­ing mul­ti­ple lo­cal au­thor­i­ties were made part of a sin­gle uni­fied health and so­cial care ser­vice.

In ef­fect, Wales would have three Health and So­cial Care Boards serv­ing 1.1 mil­lion pop­u­la­tion.

Gov­ern­ment must ur­gently tackle the short­age of doc­tors, nurses, health and so­cial care pro­fes­sion­als and car­ers.

In­creased re­cruit­ment and im­proved re­ten­tion of staff trained in Wales for the health and care ser­vice are es­sen­tial. Car­ers will need to be re­cruited and trained and paid a re­al­is­tic wage.

Lo­cal­ity health and care hubs would be es­tab­lished, bring­ing to­gether health, so­cial care, third sec­tor and lo­cal vol­un­teer cit­i­zens groups.

There would have to be a max­i­mum of nine hospi­tals with A&E ser­vices across Wales, two dis­trict gen­eral hospi­tals for each health and so­cial care board and one teach­ing ter­tiary health cen­tre

Sixty per cent of the in­take of Welsh health and so­cial ed­u­ca­tional in­sti­tu­tions should be from the Wales pop­u­la­tion.

There needs to be a stan­dard per­capita fixed price for health and so­cial care pro­vi­sion in or­der to en­sure eq­ui­table ac­cess and fair tax­a­tion.

Un­less the Welsh Gov­ern­ment takes ur­gent ac­tion, and im­poses a new model with agreed stan­dards and lim­its, the pop­u­la­tion of Wales will not be well served.

Tough though it may be, the mul­ti­ple bu­reau­cra­cies, the over-com­plex­ity of de­ci­sion-mak­ing and man­age­ment will have to change, jobs will be fo­cused on de­liv­ery of ser­vice and non-front­line re­dun­dan­cies will be in­evitable.

The cur­rent sham­bles is no longer sus­tain­able or fit for pur­pose.

The First Minister and the gov­ern­ment need to be held to ac­count for 10 years of poor plan­ning and failed man­age­ment.

The “blame ball” sits with the gov­ern­ment, not the NHS boards or county coun­cils and their staff, clin­i­cal, so­cial and man­age­rial for “fail­ing to de­liver”.

Wales has the op­por­tu­nity to build a na­tional health and so­cial care ser­vice fit for the next 70 years, em­body­ing the prin­ci­ples of the found­ing fa­thers, Bev­eridge and Bevan, based on fair care for all, free at point of need, but not of course “free” in re­al­ity, funded from our taxes by the tax­pay­ers.

We, the pub­lic will have to ac­cept our re­spon­si­bil­i­ties for our own health and the care and sup­port of our fel­low cit­i­zens.

If we will not care for our ageing rel­a­tives we must pay the taxes re­quired. We don’t need to end­lessly con­sult; we know what we need and want.

The new First Minister, pre­vi­ously re­spon­si­ble for health and so­cial care, needs to re­view the failed Welsh NHS and im­plod­ing so­cial care ser­vices, and ur­gently pro­duce work­able long-term, ef­fec­tive, funded solutions. Shuf­fling the chairs in the cir­cle of the tired old guard will not pro­duce change.

The re­spon­si­bil­ity sits with him.

THE pic­ture painted by a for­mer hos­pi­tal di­rec­tor of an Welsh NHS in cri­sis is noth­ing short of fright­en­ing.

Dr Iain Robert­son-Steel, who re­tired this year from Withy­bush Gen­eral Hos­pi­tal, warns that last win­ter the NHS “reached the point of near cat­a­strophic fail­ure” – and that this time round things are “likely to be worse”.

With can­dour, clar­ity and high con­cern, he de­scribes a health ser­vice in which “good­will was ex­ploited”, wait­ing lists grew and the qual­ity of treat­ment de­clined.

He has writ­ten more than a polemic. He makes a pas­sion­ate call for the NHS and so­cial care to be brought to­gether, de­scrib­ing how “dis­charges of frail el­derly pa­tients be­came vir­tu­ally im­pos­si­ble”. He ar­gues that so­cial ser­vices staff did not “meet the chal­lenge by work­ing longer hours” and the “NHS took the blame”.

Dr Robert­son-Steel wants to see a “sin­gle Na­tional Health and Care Ser­vice” and says Mark Drake­ford, as First Minister, must grasp the op­por­tu­nity to bring about change or “re­sign within the year”.

His vi­sion of so­cial care work­ing in part­ner­ship with the NHS will re­ceive wide­spread and strong sup­port, even if his spe­cific rec­om­men­da­tions for how this would work in prac­tice may prove con­tro­ver­sial.

Crit­ics of the Welsh Gov­ern­ment will share the sense of dis­ap­point­ment that runs through his ar­ti­cle that “min­is­ters have failed to ad­dress the core is­sues and de­velop fit-for-pur­pose ser­vices for the fu­ture”.

How­ever, he is not de­featist and be­lieves in a tax­payer-funded NHS free at the point of need, ar­gung that a “new model of care can emerge which is sus­tain­able and af­ford­able”.

The is­sues he high­lights con­cern­ing re­cruit­ment chal­lenges are a long­stand­ing con­cern and there will be dif­fi­cul­ties ahead if it be­comes harder to re­cruit staff for ei­ther the NHS or the care sec­tor post-Brexit. He ar­gues that “mas­sive bud­get over­spends oc­curred due to a short­age of staff”, which forced the hir­ing of locum doc­tors and nurses.

Dr Robert­son-Steel’s as­sess­ment of the state of the NHS in Wales will not make easy read­ing for any­one in the Welsh Gov­ern­ment – es­pe­cially his claim that turn­around teams ended up “threat­en­ing staff”. But the in­ten­tion be­hind his in­ter­ven­tion is not to trig­ger an­other round in a blame game but to spur change. The need for world-class care is inar­guable and the chal­lenge is to de­liver it.

‘There is no doubt that the NHS reached the point of near cat­a­strophic fail­ure in win­ter 2017 – and win­ter 2018-19 is likely to be worse’

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