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Thursday, January 16, 2020

Have the Welsh Government run out of ideas on the NHS?

When I heard on the radio that Health boards in Wales could face fines for failing to tackle issues around the amount of time it takes ambulances to hand over patients to A&E departments, I did a double take.

Have we really come to the point where Ministers are so powerless to do anything about the stacking up of ambulances outside emergency rooms and 12 hour waits to be treated that they are having to resort to meaningless sanctions to punish hospitals?

The BBC reports that Health Minister Vaughan Gething is to set up a taskforce after a review of amber response times. He said he was "increasingly concerned" and would not rule out fines among a "range of options" to improve things. How exactly they will improve things remains a mystery.

There were 79,150 wasted hours - the equivalent of nine years - last year for crews waiting outside A&E. The number of patients delayed in this way in November 2019 was 513 - the highest number since March 2016. None of this is new.

As an Assembly Member I was raising similar issues ten years ago.  The fact is that the number of hospital beds have shrunk, staff recruitment is difficult especially in the nursing profession. Because beds are full then patients cannot easily be transferred from accident and emergency, this adds to the waiting time to be seen, and that means that ambulances cannot unload their patients. This, in turn, means that the number of ambulances available for emergency calls is diminished and people wait longer to be attended to.

How does a fine, or even an incentive alter this dynamic? In fact what is even meant by a fine? Hospitals are funded by public money. Is the Welsh Secretary seriously thinking of taking some of that money off them as a punishment, thus adding to their deficits, their underfunded services and overworked staff and making the whole situation worse?

The whole system approach, whereby we reduce pressure on hospitals by caring for patients in the community and though primary care centres has been talked about for decades. It involves close collaboration between social care providers (local councils) and health providers (health boards) both in terms of planning and service delivery and funding. We are still a long way from delivering on that vision.

Talk to many health care employees and they will tell you about the wasting of valuable resources, failures to cope with an increasingly complex and expensive care system and problems in liaising or working with social care providers. There is frustration and concern at all levels and in both social care and health care that the system is not working properly and that patients are losing out as a result. A lot of this is due to underfunding, but the failure to reform is also a major factor.

The Health Secretary and the Welsh Government have it within their power to deliver solutions but have failed dismally to do so. Instead they are talking about fines, incentives and task forces to look at the one aspect of health delivery that is a symptom of the problem rather that the cause. It is the surest sign yet that the politicians have run out of ideas and are instead virtue-signalling their own impotence.
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