Painting the picture: An update on the pressures facing the NHS in Wales

Over the course of August, the challenges faced by the NHS in Wales have increased even further. Demand remains sky-high (record-breaking, in some areas), social care is under increasing pressure and staff absences continue to make it very difficult to cope with high expectations from the public. It’s harder for people to understand the current system pressures compared to, for example, the peak of a Coronavirus wave and before the vaccination programme.

Our immediate priority continues to be supporting our Members by articulating the complexity of the challenges facing the health and care system in Wales, the immediate mitigating actions our Members and colleagues in social care are taking and what we require from Governments in the short and medium-term so that we have a high quality sustainable system into the future.

We have written to all Members of the Senedd setting out the key reasons for the severe pressures on the system and the serious impact this is having on service delivery. To further convey these important messages, we wrote ‘Why is the NHS at crunch point?’ for the Institute of Welsh Affairs and gave interviews to ITV Wales News and BBC Radio Wales to discuss the complex challenges facing our Members. We have directly engaged with the members of the Health and Social Care Committee and party spokespeople, providing a national picture to build on the excellent work being done by Members locally.

We highlighted the pressure on services in our response to the Welsh Government’s decision to move to Alert Level 0, praising the role and success of the vaccination programme and urging those not vaccinated to come forward. Most recently, we responded to the release of the NHS performance and activity statistics for June and July, which followed the announcement from Welsh Government for an extra £551m funding to help health and social services in Wales recover from the pandemic. It was stated that £140m of the total would be put towards tackling waiting list backlogs and rebuilding after Covid.

At the time of writing, there are 1,400 patients in Wales who were clinically optimised and ready for discharge, but the support they need to leave hospital is not available. This has the equivalent impact on bed capacity to shutting the University Hospital of Wales in Cardiff.

To illustrate the levels of demand the NHS is currently experiencing, performance statistics for July saw the highest daily average number of calls to the ambulance service recorded since the pandemic began and the third highest daily average total calls since comparable data was first collected. July also saw a record high percentage of calls to the ambulance service as immediately life threatening (red calls) and the second highest daily average number of amber calls since records began. This was compounded by the 94,000 patients that attended emergency departments across Wales, contributing to ambulance handover delays.

There’s no doubt that Covid has also affected performance in planned care and will continue to do so. Numbers waiting for referrals, diagnostic tests, therapies and treatments have continued to increase over the course of the pandemic, and whilst leaders and staff are doing all they can do address the backlog, the combination of factors outlined in our recent communications have too much of a significant impact on service delivery to make meaningful progress in planned care activity.

One area that is coming to the forefront of debate is the tremendous pressure facing the social care sector and the subsequent impact on the ability of the NHS to continue delivering services. The challenges facing social care services include vulnerabilities in funding and market stability, increased demand, growing unmet need and high levels of staff vacancies.

NHS leaders are working closely with local authority partners to find solutions to the challenges faced, but the sector needs a new funding settlement which stabilises its current position and allows it to undertake long term planning and therefore to recruit and retain staff.

We know the NHS doesn’t act in isolation, and issues of capacity and workforce in social care are having serious implications on the NHS, namely the inability to discharge large numbers of medically fit patients from hospital. At the time of writing, there are 1,400 patients in Wales who were clinically optimised and ready for discharge, but the support they need to leave hospital is not available. This has the equivalent impact on bed capacity to shutting the University Hospital of Wales in Cardiff.

NHS leaders are undertaking significant work with local authority partners to minimise disruption, but the long-standing issues within the care sector further add to the urgency in existing calls for Governments across the UK to support integration between health and care and create a sustainable financial model for the sector.

The WeCare.Wales campaign is receiving a renewed focus, promoting the benefits of working in care and providing a glimpse into various job roles within the social care sector. Partners and stakeholders across health and care (and beyond) are encouraged to spread the message far and wide, on social media and through the networks and channels at their disposal.

To aid the effort to address some of these challenges, we’ve been working closely with our Members and colleagues in the care sector, as well as engaging with Members of the Senedd, to gather information and highlight key issues. The current pressures on health and care are extreme, but we must continue to look ahead and think about what we want the health and care system to look like. There’s much to build on and work towards for NHS leaders in Wales.

As part of this, the Welsh NHS Confederation invite you to join us at our virtual Wellbeing for Wales Lecture Series, where we will discuss the ongoing challenges faced by the system, highlight examples of best practice, share ideas, opportunities and future plans so that we can build and develop a health and care system that can meet the challenges ahead and improve the lives of people in Wales.

We look forward to seeing you there.