The state of the Wales NHS: A view from the front line.

The Tories and Reform UK regularly use the alleged state of the NHS in Wales as a stick to beat Labour, in power for the lifetime of devolved government. British unionists use it as a stick to beat the very principle of devolution. Wales Labour, in turn, points to  free prescriptions, the abolition of the internal market, which still exists in England and, in breaking the link between clinicians and hospital administration has bred an extra layer of administrators. Otherwise, Wales Labour claims that underfunding from Westminster prevents any Welsh government from dealing with Wales’ problems of poverty, poor public health and an ageing population. Fourteen years of austerity from the Tories in Westminster has affected non-devolved areas such as benefits with obvious effects on public health, leaving the NHS in Wales to pick up the tab.

But even if much of the criticism of  the NHS in Wales is inaccurate or distorted, not everything is rosy.

According to the NHS confederation the healthcare system in Wales faces numerous challenges which impact its ability to provide timely and effective care. Identified problems are:

Accident and Emergency departments are overcrowded with patients facing long waiting times for assessment, treatment and hospital admission, due to bed shortages. There are staff shortages affecting GP services, hospitals and mental health services. There are patient flow issues, namely delays in discharging patients from hospital, leading to prolonged hospital stays which put additional pressure on the system. Patients struggle to access timely care in mental health services with long waiting lists and delay in receiving treatment after initial assessments. There are difficulties in accessing dental care, with practices struggling to meet demand. There are difficulties in accessing a GP. People in Wales also experience health inequality with unfair differences in health and access to healthcare across the population, made worse by the impact of Covid-19. There is a lack of system resilience resulting in unsafe corridor care and ambulances being delayed at hospitals.

All this has resulted in a serious problem with staff morale. Following a ballot, Health Care Support Workers (HCSW) in Swansea were on the point of walking out over the low pay. As a result, some staff will receive slightly better pay, but they have to be upskilled to receive this. 

Registered nurses are leaving the NHS in droves, which leaves us looking yet again for nurses from other parts of the world. Many of these are ‘third world’ countries that themselves can’t afford to lose their own nursing professionals. In this context, the threat by  Cardiff University, recently scaled down, to close its school of nursing is nothing short of disastrous.

It’s easy to see, therefore, that the NHS in Wales is facing a lot of problems. The more difficult task is determining whether these problems are due to a lack of resources or poor policy and decision-making. The answer is both. Wales is under-funded by Westminster. The failure to tackle the restoration of previous years’ pay, lost due to austerity policies, means many of our ancillary workers are now earning just above the minimum wage.

However, the Welsh government has decided to have a ‘strategic system change’. This seeks to  realign secondary care so there is less bed occupancy and a ‘hub and spoke’ methodology that has acute sites populating the primary care hubs. The problem is that without the buy-in and adequate funding of community settings in the primary care sector we still have delayed transfers of care across the health system. While the current situation is not sustainable, neither is reducing hospital beds without first creating a whole system solution which starts with creating capacity in the community. Therefore, health workers received the news that there are ‘too many beds’ in secondary, acute care with horror, laughter and exhaustion. We are seeing with our own eyes that there are not enough beds and we see who suffers.

An example of where things are going wrong is the frightening situation in Morriston Hospital Accident and Emergency, which has seen the only acute hospital in Swansea being unable to cope with the huge pressures placed upon it. As a result, Swansea Bay University Health Board has stated, euphemistically, that it has had to ‘flex its capacity’ at Gorseinon Hospital in Swansea. What that means is overcrowding and a loss of privacy. It is not surprising there have been several outbreaks of flu and norovirus in hospitals in Wales.

The outcome is that staff are burnt-out and frustrated. Morale is at an all-time low as a result of decisions made by Health Board executives who are a long way from the care they claim to be providing for the people of Wales. Politicians, when they are ill (and we would not wish it on them) should experience the same level of care as Mrs Jones, 94 years old, living alone, who has fallen and broken her hip.

Wales’ Labour’s excuse was that it was doing its best in the face of a hostile government at Westminster. Last year, we thought, with excitement, ‘at last we have a Labour government in London’ but that excitement lasted only a few moments. What we have is a Labour party, in London and Cardiff, that is representing corporate interests and doing what every trade unionist has witnessed in their working lives under the Tories, safeguarding the interests of the rich at the expense of the working class low-paid. If there are cuts to the NHS budget it will be at the expense of the low-paid, not the corporate structure. Six figure salaries are being paid to new managers to manage change which will result in attacks on overtime. There are to be changes to shift patterns; extremely important to health workers are the extra duties payments that follow shift work that can bring nearly a third extra wages at the end of the month. (Every health worker loves a Sunday shift with extra duties payments, unless you’re a doctor, and very few managers around: the dream shift.)

So, if we were in any doubt about what was to be delivered by Starmer’s cabinet we did not have to wait long. We  had the continuation of the two child limit in child benefit, a major driver of child poverty. The abolition of the winter fuel allowance will push poorer pensioners into both fuel poverty and absolute poverty. Everyone knows that the people most at risk will not claim pension credit guarantee because it’s too complex, or because they’re too proud. All these measures damage public health,  putting pressure on the health service and those who work in it.

Experts at the NHS confederation have called for a ‘multifaceted approach’ to address the complex challenges facing healthcare in Wales to ensure the delivery of safe, effective and patient-centred care. This would involve recruiting, training and supporting the right workforce as well as ‘sustaining agility in decision-making’ to respond to changing demands.

Libby Nolan is a member of Unison National Executive Committee and was President of the Union 2023/24.

Joe Hale is Chair of the Swansea Bay Health Authority Unison health branch.