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What lies ahead for healthcare in Wales in 2017 and beyond? | Michael Trickey

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With a narrow window in which to move the Welsh NHS onto a pathway to sustainability, Michael Trickey considers what needs to happen in the years ahead.  

Positive headlines in Wales about the ambulance service and organ donation, along with a better-than-expected budget for next year, provided an encouraging back drop for last week’s Team Wales event, bringing together leaders from across the NHS in Wales. But leaders know that they have a narrow window in which to move the Welsh NHS onto a pathway to sustainability.

The good news, as Anita Charlesworth reminded the team, is the Health Foundation’s recent conclusion that the NHS in Wales is financially sustainable for the long term. This takes account of rising demand, but is subject to a number of caveats, such as annual efficiencies of 1 per cent, NHS budgets rising in line with GDP and good quality social care and community support services. 

But we still have several further years of austerity to get through first.

Although there have been annual real-terms increases in the Welsh NHS budget since 2013/14, the prospects from 2018/19 onwards look less promising. The Chancellor’s Autumn Statement has not altered the view that the flattening out of the Treasury’s planned increases in English NHS spending will impact on the block grant to Wales.   

To balance the books over the next few years, the Welsh NHS will have to maintain the current pay policy and deliver around £100 million or more in recurrent efficiencies each year. Wales needs to   close the funding gap and also release funds to invest in long-term transformation to drive up productivity and reshape services for the future.  

Such a figure is not out of line with historic performance on efficiency, but the going is getting harder. 

Lord Carter of Coles briefed Team Wales on his efficiency programme for the acute sector in England and the potential savings that could be achieved through a relentless drive to remedy unwarranted cost and activity variation between hospitals. His emphasis on better metrics and their better use is an important message for Wales. The next phase of his work, on primary and community services in England, could also prove highly relevant. 

But there is wide agreement that efficiency is not just a technical matter – it is more profoundly about finding better ways of using resources to achieve better outcomes for the community in a context where, as Sir Muir Gray advised the team, demand is rising by 20 per cent in the next. 

The promulgation in Wales of the Prudent Healthcare principles developed by the Bevan Commission – healthcare which fits the needs and circumstances of patients and avoids wasteful care – is seen as providing the basis for a value-based approach. 

Issues such as shifting resource and practice from low-value interventions in terms of people’s outcomes to high value, and developing budgets which reflect population needs, were discussed. 

Does the balance between self-care, informal care, generalist care and specialist care need to change, as part of a new revolution in healthcare which takes account, for example, the impact of digital technology on relationships with the public? 

The question is how to translate the many practical, individual, examples of innovation and evidence-based change in Wales presented at our recent event into system change. The new parliamentary inquiry into health and social care in Wales will be crucial in fleshing out a vision which can be translated into a strategy and a plan.  

Change is never easy – some difficult decisions about organising specialist care and a regional approach await, for example. And it may be here that the biggest question about future change surfaces. 

The NHS is one of the few public institutions not to have nose-dived in terms of public respect. But communication in a ‘post-truth’ world presents formidable challenges. The frequent reference to the need for ‘conversations’ with the public about health needs and priorities may not do justice to the scale of the task ahead. 

How the public is engaged in achieving the transformation will require as much innovation as healthcare practice itself.  

Michael Trickey is the director of Wales Public Services 2025. Follow the organisation on Twitter @WPS2025

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