Why Is the NHS at Crunch Point?

A colourful NHS logo over a pink heart, painted on the ground. Photo by Nicolas J Leclercq on Unsplash.

Darren Hughes from the Welsh NHS Confederation argues broader reforms are needed to counter the pressures facing the NHS in Wales.

As we enter August, Covid cases appear to be stabilising and the vaccination programme continues to reach new heights (on 29 July, over 80% of the adult population in Wales had been fully vaccinated). So why are NHS services struggling to cope with the significant demand on its services?

As ever, there’s no simple answer to that question. The cumulative impact of a combination of factors at play across the entire health and care system have led us to this point.

Leaders across the system report feeling pressures usually only felt at the height of winter (something they’re seeing as a worrying trend in recent years), and feel strongly that we’re nowhere near a position of ‘recovery’.

“Despite the reassuring defence of the vaccine, Covid is continuing to impact capacity.

In many areas across the NHS and social care, we’re seeing the highest levels of demand on record, combined with restricted capacity, increasing patient needs and high public expectation, culminating in the greatest pressure on the NHS in a generation.

Despite the reassuring defence of the vaccine, Covid is continuing to impact capacity.

Ongoing infection prevention and control (IPC) measures within NHS sites and care settings continues to take time and use extra capacity, reducing the number of patients that can safely be treated each day.

It continues to be a priority to keep staff and patients safe and as we know, even with high standards of IPC, transmission can still occur.

As restrictions have lifted and public behaviour has changed, cases of Coronavirus have risen, resulting in a small increase of Covid patients in hospital and more staff, who live and work in our communities, needing to isolate due to close contact.

We know the vaccine is working, but even the smallest of increases in Covid patients in hospitals and intensive care units has a disproportionate effect on the capacity to treat all patients.

There’s also a growing number of people suffering from the longer-term effects of the virus, even if their initial symptoms are mild. It appears there’s no clear evidence yet as to who might experience these longer-term effects, but reports suggest it could affect nearly one in nine people aged 17-24.

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Many staff are exhausted post-Covid, with wider longer term workforce challenges compounding the situation. High absence rates, primarily due to stress, psychological issues, needing to self-isolate or suffering from the effects of Covid-19, are exacerbating pre-existing staffing issues.

We need to make sure staff are looking after themselves to ensure they can care for others, by taking postponed annual leave and ensuring they have time to focus on their own wellbeing.

“No one service acts in isolation and we must acknowledge that this is a whole-system issue.

Ambulance services and Emergency Departments (EDs) have experienced record levels of demand in recent weeks, with reports of long waits and handover delays across Wales. Much of this demand is from those in urgent, life-threatening situations, but some comes from frustrated patients not knowing where else to turn to access services.

Some EDs have experienced high staff sickness rates, necessitating urgent redeployment of staff from other services, another factor greatly affecting the ability to deal with those waiting for planned treatment. 

But no one service acts in isolation and we must acknowledge that this is a whole-system issue. Demand is increasing across primary, community, social care and mental health services and across the wider public sector. 

In particular, challenges faced by social care partners have a significant impact on the NHS, especially in relation to supporting people to remain well at home and to discharge people from hospital. This includes similar, if not more serious, workforce capacity issues than within the NHS. 

Whilst NHS leaders constantly engage with local authority partners to minimise disruption and work through issues, there’s no denying the social care sector is in crisis. These long-standing problems should act as fuel for Governments across the UK to reform social care and further support the integration between health and care. 

“It’s hard for the public to understand why the NHS isn’t recovering all services at pace

We cannot wait – the time for action on this is now. Both the Welsh NHS and the people of Wales need a financially sustainable care sector and a properly paid and supported workforce.

Not unsurprisingly, the public’s tolerance for service disruption is dwindling and their expectations of the NHS have risen as “life returns to normal”. In previous Covid peaks, it was easier to understand why there was so much pressure on services.

But as we see impressive vaccination rates and the subsequent positive effect on hospitalisations, it’s hard for the public to understand why the NHS isn’t recovering all services at pace. The combination of factors means that the speed of elective recovery isn’t going to be what the public or NHS leaders would like it to be. 

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NHS leaders are all too aware that thousands of patients have been waiting for months for treatment or surgery, and work is constantly being undertaken to ensure patients are kept well-informed and supported while they wait.

However, this shouldn’t take away from the significant strides that have been taken to address the backlog, transform services and care for patients. It’s important to stress that although there are pressures on services across the board, many are coping. This is, in part, thanks to inspiring innovations and transformation in services resulting from the pandemic and the hard work and determination of staff. 

There’s much collective learning to be done here and harnessing the speed and agility of service adaptation is being considered and must contribute to future ways of working. The delivery of Wales’ world-leading vaccination programme is a prime example of this, at scale. 

Staff and partners from across health, social care, the third sector and beyond have come together to deliver the unachievable for the collective benefit of the country, through a combination of planning, agility, partnership working across boundaries and outside of silos, clear communication, and efficient redeployment of resources. Not all examples are of this scale, but they all have improved patient outcomes at their heart.

“Slow burn issues […] must be balanced with short-term service change and investment.

We know that severe pressures are being felt across health and social care, hence a whole-system approach is requisite to meet these challenges, so services can provide the care and treatment needed. 

We need to learn to live with Covid, but the question is how we get as many services as possible on stream without compromising patient safety and incurring an overwhelmed workforce.

There is no magic bullet, but there are essential longer-term changes that can be made – ensuring a sustainable social care and support system and affecting public behaviour, for example. These are slow burn issues and must be balanced with short-term service change and investment. 

NHS leaders will do all they can to provide the best possible care to all, but improving the current situation is not something they can do alone.

We need a clear multi-year financial settlement from Governments so we can plan and transform services and we urgently need the public to continue to help the NHS by using services appropriate to their needs whenever they can. This means using the NHS 111 Wales website and online symptom checker and resources such as community pharmacies wherever possible.


All articles published on the welsh agenda are subject to IWA’s disclaimer.

Darren Hughes is the Director at the Welsh NHS Confederation, the membership body representing all the organisations making up the NHS in Wales.

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