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NHS Wales workforce crisis: Audit Wales report highlights key challenges

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A NEW report from Audit Wales has exposed critical workforce challenges in NHS Wales, citing gaps in workforce planning, recruitment and retention difficulties, and ongoing reliance on temporary staff. Despite some progress in reducing agency spending and sickness absence rates, the healthcare system remains under strain, with concerns over leadership, data collection, and long-term sustainability.

Workforce planning shortcomings

NHS staff: Under pressure and burning out, says report (Image: HDUHB)

Audit Wales identifies significant flaws in workforce data collection, making it difficult for NHS Wales to effectively plan for future demands. The lack of accurate, up-to-date data hinders efforts to address shortages and distribute resources efficiently.

The report also raises concerns over unclear national oversight, leading to inconsistent workforce planning across different health boards. There is no single entity fully accountable for ensuring a sustainable workforce, contributing to fragmented decision-making.

Persistent recruitment and retention struggles

Despite recruitment initiatives, NHS Wales continues to face staffing shortages, particularly in specialist medical fields and general practice. Doctors and nurses leave the profession due to stress, burnout, and lack of career progression opportunities. The retention crisis is worsening existing pressures on remaining staff, who are forced to work longer hours under increasingly challenging conditions.

Reliance on temporary staff still a concern

Withybush Hospital in Haverfordwest now uses less agency nurses, but is still reliant on them (Image: Herald)

While NHS Wales has reduced its reliance on agency workers, the expenditure on temporary staff remains substantial, putting pressure on budgets. Health boards are still heavily dependent on locums and bank staff to fill gaps, leading to inconsistencies in patient care.

Audit Wales Report calls for “collective action”

Audit Wales has published a report today detailing the workforce challenges at the heart of the Welsh NHS, calling for “collective action”, highlighting a reliance on “expensive” agency staff to “plug gaps in the workforce”.

Auditor General for Wales, Adrian Crompton, stated that “the NHS in Wales continues to face significant workforce challenges” and that service demand “is expected to grow further”.

The report highlights over 5,600 vacancies in NHS Wales, with over 10% of medical and dental posts currently unfilled. While agency staff expenditure has decreased, it still cost the NHS £262 million in 2023-24. The growing workforce is welcome but comes at a financial cost, with NHS staffing costs rising by 62% since 2017-18, reaching £5.23 billion in 2023-24. The report raises concerns over whether continued workforce expansion is financially sustainable in the long term.

BMA Cymru Wales criticism

In response to the report, BMA Cymru Wales issued a statement on February 18, 2024, emphasizing that workforce gaps have been highlighted for over a decade, yet progress remains slow.

Dr Iona Collins, chair of the BMA’s Welsh Council, said: “Despite highlighting the need for an all-Wales workforce strategy, we have yet to see the necessary improvements in data collection to inform an appropriate long-term plan.”

The BMA argues that staff shortages contribute to delays in surgery and lengthening waiting lists, causing avoidable harm to patients. They also point out that Wales has fewer doctors per head of population compared to the rest of the UK, exacerbating service pressures.

Welsh Conservatives criticise Labour Government

James Evans MS: Says Labour have ‘failed to deliver’

Welsh Conservative James Evans MS has criticised the Welsh Labour Government for failing to bring forward a substantial workforce plan to meet the needs of the Welsh NHS and the public.

Commenting, Welsh Conservative Shadow Cabinet Secretary for Health and Social Care, James Evans MS, said: “The Welsh Labour Government have comprehensively failed to bring forward the substantial workforce plan that the Welsh NHS needs to serve the public.”

“Without proper planning, we remain stuck in a perpetual cycle of less money being available to repair the foundations of the NHS, because disproportionate funding is going towards costly agency staff.”

“Welsh Conservatives will bring forward the recruitment and retention plan needed to fix the Welsh NHS, because Wales deserves better than this Welsh Labour Government.”

Impact on patient care

The consequences of the workforce crisis are already affecting patient care, with reports of longer waiting times, postponed surgeries, and staff shortages in key areas. The current workforce struggles are leading to avoidable harm for patients, as well as knock-on effects on their families and employers.

Calls for immediate action

The Audit Wales report calls for a comprehensive, long-term workforce strategy to address these challenges. Recommendations include:

  • Better workforce data collection and planning
  • Stronger leadership and accountability at a national level
  • More investment in training and retention strategies
  • Reducing dependency on agency staff through improved workforce stability
  • Developing a clear long-term educational and funding plan to ensure NHS Wales can retain the staff it trains
  • Creating a sustainable workforce model for social care to better integrate services

The report highlights the lack of clarity over system leadership arrangements, making workforce planning even more challenging. Health Education and Improvement Wales (HEIW) plays a key role, but its relationship with other NHS workforce organisations needs to be clarified. Workforce planning is also hindered by gaps in data and uncertainty about the future of health and care services.

With mounting pressures on NHS Wales, swift action is essential to prevent further deterioration in services. The Welsh Government is now under pressure to respond decisively to these findings and implement sustainable solutions to support the NHS workforce in the long term.

 

Health

The growing popularity of overseas medical care

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With waiting lists ever increasing and appointments seemingly booked up forever, more and more people are seeking alternative methods to get the medical care they need. While going private is an option for some, for others, the costs are simply too high, treatments are not specialised enough, or waiting lists remain lengthy. This is why many people are starting to go abroad for their treatment needs. So, with that in mind, let’s explore why overseas medical care has grown in popularity. 

Shorter wait times 

In 2024, more than 500,000 Britons chose to get treated abroad to avoid lengthy wait times on the NHS, more than double compared to numbers reported in 2021. With waiting lists continuously on the rise, it’s becoming increasingly difficult for people to get the treatment they need when they need it. The result is more and more people heading overseas to receive the right medical care. 

Lower costs

The expense of going private in the UK versus going private abroad is significant. For example a hip replacement in the UK costs around £12,000 to £18,000 privately, but will cost around £1,600 to £5,000 in India. These reduced expenses make medical care more accessible to those on lower incomes, increasing the appeal of overseas medical care. 

Specialised treatments or experimental therapies

Some countries have dedicated more time and effort into certain health conditions than others. For example many people seek epilepsy treatment in Germany, thanks to the country’s reputation for advanced investment into the condition. 

Some tests, treatments, and experimental therapies aren’t available in the UK, causing people to venture further afield to make progress with their health. 

Easier access to information

Thanks to technology like the internet and social media, it’s now easier than ever to research practices, facilities, and treatment options in different countries. Those who are dubious about going abroad for medical treatment, can now get the reassurance they need to go ahead. 

And it’s not just the treatment itself, but the travel and accommodation, too. It’s never been easier to compare prices for airplane tickets, hotels, and transfers, making the entire process straightforward. 

What does the future of medical care look like?

It’s evident that for Brits, going overseas is becoming increasingly popular. As NHS wait times and private costs increase, the appeal of treatment overbroad will likely continue to rise. 

 

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Health

£2m hospital upgrade to ease A&E pressure at Carmarthen site

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MAJOR refurbishment work has begun at Hywel Dda University Health Board’s Glangwili Hospital after more than £2 million in funding was secured from the Welsh Government.

The £2.096m investment will be used to overhaul the hospital’s Same Day Emergency Care (SDEC) unit, creating extra consultation rooms, a redesigned reception, and a more comfortable environment for both patients and staff.

Health chiefs say the expanded unit will help reduce pressure on the hospital’s busy Emergency Department by allowing more people to be treated quickly without needing an overnight stay.

The project forms part of wider efforts to improve urgent and emergency care across the health board’s sites, including the Minor Injury Unit at Prince Philip Hospital.

Keith Jones, Director of Operational Planning and Performance for the health board, said the funding would increase capacity and speed up patient flow.

He said: “This investment will help us reduce pressure on the Emergency Department and provide a smoother, swifter experience for patients. We’re grateful to Welsh Government for the support.”

Services temporarily relocated

While the work takes place, several services have moved elsewhere on the hospital site.

The SDEC unit, Discharge Lounge and Medical Day Unit have relocated to Y Lolfa, formerly Padarn Ward.

The Cancer Information and Support Service and Cancer Psychological Support Service have also moved, although contact details remain unchanged.

Some clinics, including podiatry, neuro-rehabilitation and occupational therapy, will stay at the Priory Day Hospital, but patients may need to use different access routes.

Patients are being notified through appointment letters, and extra signage will be in place around the hospital. Staff are urging visitors to check their letters carefully or contact departments directly if unsure where to attend.

Cabinet Secretary for Health and Social Care Jeremy Miles said the upgrade would help tackle overcrowding and delays.

He said: “This investment will reduce waits, ease handover pressures and improve the overall experience for patients and staff when they need urgent or emergency care.”

Work is expected to continue over the coming months.

 

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Community

Work on new 26-home Pembrokeshire development gets underway

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CONSTRUCTION work has started on a Haverfordwest scheme to provide sheltered housing apartments for the over-55s.

The Tŷ Haverfordia affordable housing and reablement development of 26 sheltered housing apartments for the over-55s alongside a dedicated 12-bed reablement centre to support residents returning home from hospital at the former Haverfordia House site, delivered by Wynne Construction, forms part of Pembrokeshire County Council’s “continued commitment to increasing high‑quality, accessible housing and deliver effective modern health and social care support across Pembrokeshire”.

Initial works began on January 26 and include securing the site, setting up a small compound and contractor parking area, installing controlled access for site personnel, and positioning temporary office and welfare units.

To maintain safe access to nearby facilities, including the GP surgery and Haverfordwest Leisure Centre, pedestrian routes through the area will remain open.

In addition, a minimum number of public parking spaces, including disabled bays, have been kept with Pay & Display machines relocated to reduce inconvenience.

In keeping the minimum number of parking spaces as well as needing to accommodate essential contractor welfare facilities, a small section of Rifleman Field has had to be used during the duration of the development of the site.

This space will be securely fenced off, and the footprint minimised. Any areas of Rifleman Field affected by the works will be fully reinstated on completion and restored to a condition that is equal to or better than at present.

To ensure residents and stakeholders are kept informed and have the opportunity to engage with the development, Pembrokeshire Housing Services will be hosting a Community Engagement Drop-in Event on Thursday, February 19, 5-7pm, at The Green Room, Haverfordwest Leisure Centre.

Pembrokeshire County Council Cabinet Member for Housing, Cllr Michelle Bateman, said: “I am pleased that we have finally reached the stage of commencing on site and look forward to seeing the development progressing.

“We have been able to progress with the development after receiving much-needed Welsh Government grant assistance for both the reablement and housing parts of the development.”

Last year, Pembrokeshire County Council’s Cabinet, members approved awarding a fixed contract of £13,560,454.21 to C Wynne & Son for the Haverfordia House works.

In 2019, Cabinet backed the acquisition of the freehold of Haverfordia House, with the overall intention to deliver a new housing and wellbeing facility following its demolition.

A report for members at last year’s June meeting said: “As well as providing long-term residents with a sense of place and community, it will provide short-term reablement users with the facilities and in-house support which they need to relearn the skills required to keep them safe and independent when they return home.”

It said there was a need for one-bed properties, and a review of sheltered over 55 accommodation was undertaken in 2018-19 which identified that existing sheltered housing stock is “no longer fit for purpose”.

 

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