News from Wales March 2013

NHS Wales, like other parts of the NHS, is facing major change as it struggles to cope with rising demand, professional demands for change, and severe financial pressures.

Unlike England, Wales has a number of distinctive features. It has little legacy from hospital PFI schemes (only one significant scheme in Port Talbot that carries a financial legacy). It retains Community Health Councils and their statutory place in the consultation processes that have to be followed when service changes are mooted. More significantly, the impact of public spending cuts impacts on the Welsh NHS in a particular way because of the workings of the Barnett formula. Simply put, Wales has for many years had to “top up” the amount received under Barnett for health care by raiding other budget heads. In 2012, this option was judged to be no longer tenable by Welsh Government (the consequential effect on Local Government spending would have been massive). Hence financial pressures have intensified.

Added to these woes, parts of Wales have struggled for many years to address the needs of sparsely populated areas remote from major centres.

The current position is that NHS Wales is in the process of a country wide redesign of its acute hospital services. Main changes proposed would see the reduction in the number of Accident and Emergency Units and emergency admitting hospitals, a switch from using  acute beds to using community based “virtual wards”, and a reduced number of specialist  services such as neonatal intensive care. An inevitable result would be greatly increased travel times (by road and air ambulance) for acute admissions and either lengthy travel distances for relatives or more inter agency “step –down” hospital transfers.

A further feature is the loss of small, local community hospitals, some of which are steeped in the pre NHS voluntary hospital movement.

Naturally local opposition to changes has been vociferous and differences between Labour AMs and Labour MPs have emerged with the latter seeming to criticise the former. This week, health minister Lesley Griffiths was replaced by Mark Drakeford who was Rhodri Morgan’s special adviser before becoming an AM; Lesley has moved to Local Government.

SHA Wales has followed the planned changes closely. It has supported the changes aimed at securing the safety of major trauma and complex surgical services, provided that necessary road / air ambulance and public transport changes are made. It is less convinced that emergency arrangements for medical (often elderly) assessment and admission need radical change. SHA Wales is also concerned that the all Wales capacity planned for key hospital services (assessment and admission services, bed capacity for emergencies, theatre capacity, ITU)  does not appears to be available; neither is  information visible for the required 999 road and air ambulance capacity or for community based “virtual wards” that are meant to replace lost acute hospital beds.