The Welsh Government needs to step up

How can we improve healthcare in Wales?

Morning all,

A massive thank you to everyone who shared and promoted the last newsletter. There was a big spike in subscribers, I am very grateful.

Just before Christmas my phone rang with a Cardiff number. It was a doctor at the UHW asking if I was free at the weekend to come in for an appointment for which I have been on a waiting list for just over two years.

When I sat in the waiting room I got chatting to some of the other people there. Given I was waiting to see an asthma specialist the chat wasn’t the quickest or most energetic, but it passed the time. Me and the old boy next to me were comparing our types of inhalers as other men might compare cars.

But between our wheezy inhales it struck me that, as I have waited for 25 months for this appointment, I was one of the lucky ones as this chap had been waiting for over four years. This actually seemed to annoy the woman opposite who had been acting like a martyr for waiting three. It was like Top Trumps for the lung-impaired.

The reason we had all been called in was part of First Minister Eluned Morgan’s drive to reduce NHS waiting lists (of over two years) by 66% by the spring. Healthcare is the biggest issue for people in Wales according to polls and in the last week there have been a series of reports and announcements that really deserve your attention. That is why this newsletter is all about health.

First, I would like to share a few words from our excellent sponsor who is so important to supporting this newsletter.

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For those of you who also enjoy my podcast (For Wales, See Wales), I have some exciting news. We will be doing a live show at the Glee Club in Cardiff on March 2.

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The worst thing I ever have to write - a clarification

Before we dive into health I want to make a little clarification. Last week when we looked at the readers' predictions I briefly discussed the chances of Eluned Morgan calling an early election. I said I didn’t think it was likely but I suggested that it wasn’t impossible.

In retrospect, I probably should have been more dismissive of the possibility of it happening. An early election would require majority support in the Senedd which, although not impossible, is unlikely.

However the biggest sticking point is that the election in 2026 will be based on new conduct rules and automatic registration. There is a convention in place requiring everything to be in place six months ahead of the election. Last week the Welsh Gov passed regulations which will allow for an automatic registration pilot which has to take place before implementation so while it is perhaps technically possible, the tight timeframes mean that an early election is remote in the extreme. Not the biggest error a journalist can make, but I thought it was important to clarify. Big thanks to the reader (who loves parliamentary procedure) for the heads up.

What’s killing Wales?

We have talked a lot about waiting lists in my newsletters. The latest waiting list data will be on Thursday so we will look at that next week. While the longest waits get the most attention and are the stick most used to beat the Welsh Government’s record, there are other areas of concern.

While a two year wait for a hip replacement is unacceptable and hugely life-limiting for the person in question, a three month wait for someone with cancer is likely to have a far worse outcome. Last week Audit Wales published a report into cancer care in Wales.

Now one of my biggest pet peeves in journalism is the overuse of the phrase “damning”. It rivals “perfect storm” when it comes to grinding my gears through overuse. Please bear that in mind when I tell you that this report was damning.

Here are some of the findings:

• While 75% of cancer patients should start their first treatment within 62 days, no health board has met the target since August 2020, despite increased investment.

• The target has never been met on an all-Wales level.

• Waiting times for some cancer types, such as lower gastrointestinal, gynaecological, and urological cancers see some patients waiting more than 100 days to start treatment.

• Wales has the second highest cancer mortality rate in the UK after Scotland.

• The UK itself has a worse rate than many OECD countries.

• Mortality rates in Wales are significantly worse for people living in deprived areas and the gap between the most and least deprived is growing.

• There are inaccuracies in national data and a need for more consistent national data that helps track delivery across the patient pathway.

• Work is underway to replace the previous outdated cancer information system but “progress has been slow, and services continue to rely on fragmented digital systems that consume time and carry risks to patient safety.”

When you go through the report (which you can read here) the thing that is most striking again and again is an apparent lack of leadership. The report concludes that:

“Stronger and clearer national leadership is urgently needed to help drive the necessary improvements in the timeliness and sustainability of cancer diagnosis and treatment.“

This was the statement from auditor general Adrian Crompton:

"Variations in performance and outcomes persist within and between health bodies in Wales, and insufficient attention is being placed on prevention of the lifestyle factors that can cause cancer and other major health conditions.

"The arrangements for the national leadership and oversight of cancer services in Wales need to be clarified and strengthened as a matter of urgency.”

I think the key here is that this is a matter of governance. Yes budgets have been tight but when you read the report you are not struck by the lack of resources. Instead what comes up time and again is a lack of strong leadership and joined up thinking. There is simply no way that the Welsh Government can pass the buck on this.

The Welsh Government is responsible for setting the vision and targets for health care and for the allocation of funding. This damning (yes damning) report demonstrates a government that is drifting and failing to live up to the already low standards set by the wider UK.

The madness of the meeting rooms part 2 - an example of a wider problem

Long term subscribers to this newsletter will remember back in September last year when I reported how it is now impossible to book a meeting room at the University Hospital of Wales (the third largest university hospital in the UK).

The old system of booking was removed in August and an alternative hasn't been put in place. This means that if someone wants to book a meeting room for any reason they can't. So if you have a disciplinary meeting, or want to bring a team together to plan a strategy, you simply can’t book anywhere in advance.

Some staff are actually paying the sports centre on the site £50 an hour to book their rooms just to be sure they can have a space.

At the time Cardiff and Vale Health Board told me:

“The Health Board is currently working closely with colleagues in Medical Education to introduce an alternative booking system until a long term solution has been found.”

We are now in January 2025 and, as of last week, this has still not been fixed.

Clearly this is just a small thing in the grand scheme of things when you’re talking about a health service with a budget over £10bn. But this issue is symptomatic of a system that is straining and creaking. Wholesale reform is needed to how the Welsh NHS operates and how healthcare is delivered and I think a strong argument can be made that the Welsh Labour government doesn’t seem to have the appetite for it.

Jeremy Miles health minister and responsible for the Welsh NHS

How can we make things better?

I am very conscious that I don’t want this newsletter to simply be me sniping and pointing out problems. There is a lot of that in the media so let’s now discuss how the situation could be improved.

Poor healthcare does not happen in a vacuum

You simply can not talk about Wales’ health crisis without talking about poverty.

Wales has the highest proportion of poor housing among the UK nations, largely due to its older housing stock. Poor housing has so many impacts on health. It was made very real during Covid when people in flats had significantly worse outcomes across numerous indicators compared to those in larger houses. But outside of the pandemic, issues such as damp, cold and mould all add more pressure onto the health service.

The stats around poverty and health are shocking.

Earlier we mentioned that cancer mortality rates in Wales are significantly worse for people living in deprived areas and the gap between the most and least deprived is growing. This doesn’t just apply to cancer. People living in the most deprived communities are nearly four times more likely to die from avoidable causes (3.7 times for males and 3.8 times for females).

Perhaps the starkest statistic is that there is a 17-year gap in healthy life expectancy for women living in the most and least deprived areas of Wales. This gap is 13 years for men.

When I was a general reporter, the two parts of public services about which people were most likely to complain to me were A&E and schools. This wasn’t because these two areas were worse run or worse funded, actually quite the contrary. It was actually because they were one of the few public services that were still guaranteed to be open.

They are the manifestation point where the consequences of all the other poorly funded and managed public services come home to roost. If you cut youth services, social housing, and benefits while also making people wait for early intervention into health issues and at the same time give social workers a workload where good performance is impossible, the places where all these issues finally reach boiling point are A&E and schools.

Due to the fact that seemingly every issue in our society is now left to fester rather than be nipped in the bud, schools and hospitals end up having to deal with more complex issues, which are more expensive and take longer to fix.

Prevention is better (and cheaper) than cure

Public Health Wales (PHW) just published a really interesting report into how effective prevention programmes are such good value for money when it comes to healthcare.

Though it is fairly obvious that preventing people getting sick is better than curing them when they are, the numbers are really stark.

Prevention initiatives such as early years education, vaccination programmes, smoking cessation and support for carers can deliver excellent value for money - with an average return of £14 for every £1 invested in them.

The report looks at successful programmes from three stages of life: early years and children, healthy adults, and healthy ageing, and identifies specific actions which deliver real benefits to communities.

These include:

• Breastfeeding support programmes can help save the NHS £50 million a year by improving mental health and reducing hospital admissions

• Targeted group sport activities aimed at increasing physical activity show returns of between £1.91 and £22.37 per £1 invested.

• Taking a holistic approach to maintaining good health in older age through activities like fall prevention programmes, promotion of independent living and community engagement can generate a return of up to £5.18 for every £1 invested.

Much like the 20mph limit, small changes or a targeted focus on prevention measures can make huge long term health savings. There are many examples in the report but let’s just take smoking.

Smoking cessation programmes aimed at supporting pregnant women to quit smoking have been found to save £24,000 over the course of a child’s lifetime. Approximately 14% of pregnant women in Wales smoke and smoking in pregnancy is associated with a wide range of health impacts for the child such as stillbirth, neonatal death and low birth weight.

It’s not just pregnant women either. There is strong evidence that a really cost effective way to get adults of any age to stop smoking is by engagement when they are hospitalised.

Last week I interviewed Mark Drakeford regarding the issues in the Welsh NHS. I will be publishing this interview in next week's newsletter. However one of my key concerns isn’t that the Welsh Government don’t know what needs to be done, it is rather that they lack the drive or the (for want of a better word) oomph, to push through the changes that are needed. I will cover their plans next week.

Plaid Cymru’s plan to save the Welsh NHS