Health and social care in Wales is very different from other parts of the UK. Many things make Wales unique, especially its people and its geography. These two elements combine to bring Wales health and social care challenges that the other constituent countries of the UK do not face. The Welsh Government and NHS Wales have made massive improvements to healthcare in Wales since devolution, but there is still a lot of work to be done to raise standards of care.
Why is healthcare in Wales different?
The British Labor government of the late 1990s began the devolution of centralized powers from the UK to the parliaments of the constituent countries. Responsibility for NHS Wales was transferred to the Welsh Government in 1999 and since 2009 Wales manages its healthcare through seven Local Health Boards (LHBs). These councils are led by commissioners and health care 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, GP and dental services, and even pharmacies and opticians. This contrasted with the structure of health care in England until recently. Now the UK plans to follow elements of the Welsh model and remove divisions between commissioners and providers to provide a more integrated health service.
The seven LHBs and three Welsh NHS Trusts work together to deliver an efficient healthcare system using both data and public policy analysis to streamline services and reduce waiting times. By sharing resources, the Welsh Government has demonstrated that a higher standard of care and services can be provided in the UK without overspending.
The Welsh Government sets healthcare policy and funding levels for Welsh NHS Trusts and LHBs. This influence is ultimately what differentiates NHS Wales from the health services of other nations in the UK. The people of Wales, through their representatives, have used their power to shape a health system that serves them and meets their needs.
What role does the Welsh government play?
The chief health and social care officer, currently Judith Paget, is also chief executive of NHS Wales. That is set to change soon after the government commits to establishing an NHS executive for Wales. The original purpose of this role was to centralize leadership and decision-making. This direction was taken following a parliamentary review of health and social care in Wales.
This new department will be a strong executive center for the service and is intended to be a role with a clearer distinction between health and public service responsibilities. This is to give NHS Wales stronger national guidance and the role has the power to set targets for both trusts and LHBs. The new executive will work with them to raise the standard of healthcare in Wales.
Although the commitment to create an NHS executive was made in 2019, the measure is still awaiting implementation. Some independent observers fear that the powers of the new executive office have already been reduced. Healthcare across the UK has faced huge challenges over the past few years. The delay in the development of this office and how the Welsh Government proceeds with its creation will determine how NHS Wales and other Welsh health services recover.
Many in the Welsh health industry fear that until the NHS executive office is online, health care in Wales will not move forward. Further concerns were raised when the government released plans to implement a “hybrid model” for the role. Independent organisations, including patient care groups, fear the growth of NHS Wales and integrated healthcare will be hampered by this change in leadership.
How are Welsh social services contested?
Finding, training and retaining staff is becoming an incredible challenge for Welsh social services. The level of skills and experience required for quality social care is constantly increasing, but human resources are decreasing. Staff shortages have led to a decline in the quality of care that social services can provide, which has had a devastating impact on Welsh communities and patients.
There are many external forces affecting the social services workforce in Wales. The economic challenges facing the world are straining the workforce in many sectors. These same forces also create excessive demand for social services. The Welsh Government and the Local health boards and trusts are caught between growing demand and shrinking supply, further squeezing their resources.
Pay levels and poor working conditions are put forward as reasons for high vacancy rates in Welsh social services. Previously, social workers of all kinds expected to receive a premium on pay from the retail and hospitality sectors, but in the past five years the gap has leveled off. Without more investment in the people who make social services possible, the quality of care provided will continue to decline.
What challenges does healthcare in Wales face?
In recent years, healthcare systems around the world have faced unique and once-in-a-generation challenges related to the 2020 global pandemic. The Welsh healthcare response has helped contain the spread of COVID-19 and save lives. Like many other health services, NHS Wales is still recovering from the strain on funding and resources caused by the pandemic.
With every crisis comes an opportunity. Many in the Welsh health system and government see the recovery from the pandemic as a chance to reform many aspects of NHS Wales. This could provide better quality of service while reducing costs. There are systemic and workforce challenges to overcome that existed before COVID-19, and the outbreak has highlighted them. With a more robust and revamped staffing structure combined with stronger central leadership, Welsh healthcare can be better prepared for future pandemics and deliver better patient outcomes.
The Wales Center for Public Policy recently completed a comprehensive review of Welsh health services to identify areas for improvement and development as pandemic-related tensions ease. Two of the main areas for improvement are leadership and decision-making. Failure to implement the NHS executive before the pandemic is seen as a cause of service bottlenecks during the outbreak.
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Welsh healthcare providers struggled to respond quickly to the first signs of the outbreak. The lack of centralized leadership has prevented NHS Wales from being nimble and able to move resources to areas hardest hit by COVID infections. Lessons learned from the pandemic have underscored the need to centralize executive powers from a focused role.
This is why the government’s plan to create a hybrid role was met with disappointment. NHS Wales and the people of Wales deserve a health service with clear responsibilities. The redefinition of the role of the NHS executive and the authority it will have increases an already long delay in its implementation. How NHS Wales handles current challenges and responds to future tensions will be determined by the powers and portfolio of the new NHS director when the office finally opens.
The future of NHS Wales and Welsh social care will be uncertain until the role of the new NHS executive is defined and fulfilled. Decentralization has allowed Welsh health and social services to set new standards of care in the UK, but this momentum is being lost as the Welsh government wavers and changes direction.