We have reached a critical time for health and care in Wales – the points of pressure that regularly affect the performance of the system have all come together in the last few years. We are operating in a state of permanent staff shortages. Demand for services has never been higher. Health boards and Welsh councils are struggling to balance the books. Health and social care systems are beginning to buckle under the strain. Change is no longer a choice, it is an imperative.
It is into this environment that the Welsh Government released its long-awaited plan for health and social care – A Healthier Wales. After two years of consultation and collaboration through the cross-party Parliamentary Review process, the plan gives us a national direction and vision, a strengthened executive to speed up delivery, a mechanism for change in the Transformation Programme, and a pocket of money to help the process. What more do we need?
Leadership. Without strong leadership, leadership prepared to let go of old thinking and comfort zones, the plan will flounder. It is going to take courage to move the health and care systems onto one path, unravelling the complexities of funding, workforce, regional boundaries, reporting lines and more.
Political leadership must champion change and take the risks that come with doing the right thing for their constituents. The NHS and local government leadership must widen their focus from individual organisation level to regional and national priorities and solutions. Welsh Government leadership must unpick complex governance arrangements that act as a drag anchor to progress and focus on supporting and facilitating innovation and pace across the system.
Some research shows that there is not one system or methodology that delivers quality, efficient healthcare; there isn’t a magical funding formula to produce value-for-money health and care systems. Health economies that deliver the best patient and population outcomes are those that get all the component parts of the system working effectively together towards shared objectives.
Imagine what we could do if political and health and care leaders could set aside conflicting policy and process and work with a shared commitment towards excellence for the people of Wales.
Action. In A Healthier Wales we have a high-level plan and a vision but there is lots of work to do to move the vision to reality right across the health and care system. In GP surgeries and care homes, in communities and emergency departments, we need to see transformative actions, ambitious actions. Actions that will make a difference.
There has always been innovation in the NHS in Wales – we are used to doing things for ourselves as we strive to meet the needs of the people in our corner of the United Kingdom. The key now is to take the best of the initiatives and the best of the innovative thinking and, where there is evidence they work, scale them up across Wales. It is no longer acceptable to say that good practice is a poor traveller – leaders across the system have the responsibility to change that, supported by incentives and sanctions from Welsh Government if necessary.
Funding. Money is the hot topic of the moment. The Prime Minister has promised the NHS in England an extra £20 billion a year by 2023 – a 70th ‘birthday present’. Wales will receive a Barnett consequential of £1.2 billion in real terms by 2023, but it will of course be for the Welsh Government to decide how and when to spend this money. In the context of the Health Foundation projections for health and social care in Wales this funding shouldn’t be seen as the answer to all our prayers.
The Health Foundation report, The Path to Sustainability, identified that the NHS in Wales needed 2.9% per annum to 2031 just to keep the wheels on, not including annual pay awards of above 1% per annum, medical advances or improvements in access to services. At the same time the report projected the increases needed to sustain social care to be 4.1% (around £50 million) per annum. As such, we still have some way to go to finding a sustainable funding position for health and social care over the next decade.
Population health and well-being depends on much more than the NHS and social care – it comes from a good education, decent housing, from employment, lifestyle and the built and natural environment we live in. A person living in a warm and dry home is less likely to get persistent respiratory problems. A child who eats a healthy diet is less like to become overweight and suffer from the raft of medical issues associated with obesity throughout their life.
Local services continue to experience the impact of austerity to the detriment of the long-term vision of a healthier Wales. Accepting that constrained resources will continue to be a feature of public services across the UK, the real challenge for Welsh Government and public service leaders is how collectively, with citizens and partners, we can get the greatest value from the way we allocate all our resources to provide services that enhance population health and well-being.
I’m not saying the health and care system doesn’t need more money; it does if it is to cope with increased demand and complexity of illness. But if we are truly aiming for transformation, let’s look across all public service budgets, look at the baseline and identify where we can use resources better. Let’s examine our service priorities, decide what we should focus on to make the most difference to the people of Wales and then put our resources there. Digital transformation is an obvious area for collective focus – the potential quality, access and outcome benefits are huge, but only if Government and leaders are brave enough to invest the substantial time and money needed to make digital a real game changer.
A Healthier Wales is something we can all support. It has a strong vision for health and social care, one we would all like to see delivered in communities around the country. We are keen to work with the Cabinet Secretary and his officials to ensure that we make the most of the opportunity created by this plan to create a sustainable health and care system for Wales that improves health and well-being for the whole population of Wales.
All articles published on Click on Wales are subject to IWA’s disclaimer.