Health and social care in Wales is very different from the rest of the UK. What makes Wales a unique country, especially its people and geography. Both of these combine to present Wales with health and social care challenges not faced by other members of the UK. The Welsh Government and NHS Wales has made significant improvements to Welsh health care since the devolution, but much remains to be done to raise standards of care.
Why is Welsh healthcare different?
The UK Labor Government in the late 1990s initiated a centralized transfer of power from the UK to the parliaments of its member states. Responsibility for NHS Wales was transferred to her Welsh Government in 1999 and since 2009 Wales has managed healthcare through her seven Local Health Boards (LHBs). These committees are led by a commissioner and provider representatives and take an integrated approach to health care.
They offer a full range of services, combining hospital care with mental health and wellbeing, general practitioner and dental services, as well as pharmacies and opticians. This contrasted with the UK medical structure until recently. The UK now plans to follow elements of the Welsh model and remove divisions between commissioners and providers in order to provide a more integrated health service.
Seven LHBs and three Welsh NHS Trusts work together to deliver an efficient health system, streamlining services and reducing wait times, using both data and public policy analysis. By sharing resources, the Welsh government has demonstrated that in the UK it is possible to provide high standards of care and services without wasting money.
The Welsh Government sets the health policy and funding levels for the Welsh NHS Trust and LHB. It is this influence that ultimately sets NHS Wales apart from other health services in the UK. The people of Wales, through their representatives, have used their power to shape a health care system that serves them and their needs.
What role does the Welsh government play?
The current Director of Health and Social Services, Judith Padgett, is also Chief Executive of NHS Wales. This is set to change shortly after the government commits to establish a Welsh NHS Executive. The original purpose of this role was to centralize leadership and decision-making. This direction was adopted following a parliamentary review of health and social care in Wales.
This new division is intended to be a strong execution center for the service and a role that better separates medical and civil service responsibilities. This is to give NHS Wales stronger national guidance and this role has the power to set targets for both the Trust and the LHB. The new executives will work with them to raise the standard of healthcare in Wales.
A commitment to establish an NHS Executive was made in 2019, but this measure has yet to be implemented. Some independent observers are concerned that the new executive branch’s powers have already been curtailed. Healthcare across the UK has faced some major challenges over the last few years. Delays in the development of this office and how the Welsh government proceeds with its establishment will determine how NHS Wales and the rest of Wales’ health services recover.
Many in the Welsh healthcare industry are concerned that Welsh healthcare will not move forward until the NHS Secretariat is online. Further concerns were raised when the government announced plans to implement a “hybrid model” of this role. I am afraid that I will be
How are Welsh social services being challenged?
Finding, training and retaining staff has become very difficult for Welsh social services. The level of skills and experience required for quality social care is constantly improving, but the workforce is shrinking. Understaffing has led to a decline in the quality of care that social services can provide, with devastating impacts on Welsh communities and patients.
Many external factors influence the staffing levels of Welsh social services. The economic challenges facing the entire world are straining the workforce in many areas. These same forces are also creating excessive demand for social services. The Welsh Government and Local Health Boards and Trusts are caught between increased demand and reduced supply, further straining resources.
Low wages and working conditions have been highlighted as reasons for high vacancy rates in Welsh social services. Care workers of all kinds expected to be paid a premium to retail and hospitality salaries, but the gap has leveled off over the past five years. Without further investment in people enabling social services, the quality of care provided will continue to decline.
What challenges does Welsh healthcare face?
In recent years, healthcare systems around the world have faced a unique once-in-a-generation challenge due to the 2020 pandemic. Responses from Welsh health authorities have helped contain the spread of COVID-19 and saved lives. Like many other health services, NHS Wales is still recovering from the financial and resource strain caused by the pandemic.
Every crisis presents an opportunity. Many Welsh health and government officials see the recovery from the pandemic as an opportunity to reform many aspects of NHS Wales. This allows us to provide better quality of service while reducing costs. There were organizational and workforce challenges that existed before COVID-19 to overcome, and the outbreak has highlighted them. A stronger and reorganized staffing structure combined with stronger central leadership will help Welsh healthcare prepare for future pandemics and deliver better outcomes for patients.
The Welsh Center for Public Policy recently completed an in-depth review of Wells’ health services, identifying areas in need of improvement and development as pandemic-related stress subsides. Two key areas for improvement are leadership and decision-making. The failure to implement NHS executives before the pandemic is seen as a source of service bottlenecks during the outbreak.
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Welsh health care providers struggled to respond quickly to the early signs of the outbreak. The lack of centralized leadership has prevented NHS Wales from being nimble and shifting resources to areas most affected by COVID. Lessons learned in the pandemic highlight the need for centralized executive authority from focused roles.
This is why the government’s plan to create a hybrid role has been a disappointment. NHS Welsh and Welsh people deserve health care with clear accountability. Redefining the role of NHS executives and the powers they hold has already delayed implementation significantly. How NHS Wales meets current challenges and responds to future stresses will be determined by the mandate and portfolio of new NHS executives when the office is finally opened.
The future of NHS Wales and Welsh social care is uncertain until the role of the new NHS Executive is defined and filled. However, this momentum is fading while the Welsh government hesitates and changes course.
