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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

Cardigan mayor joins calls to save weekend urgent care

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PLANS to end weekend urgent care provision at Cardigan’s Integrated Care Centre have sparked a backlash, with local leaders and residents warning of serious consequences for patients across the region.

Mayor of Cardigan, Cllr Olwen Davies, has joined those calling for the weekend service to be saved, describing its withdrawal as “deeply disappointing.”

Mayor: Olwen Davies

“It’s a huge blow,” she said. “This service has proved vital not just for the town but for the wider area. With the Easter holidays upon us, it’s unthinkable that we’re losing such a key facility.”

The Welsh Government-funded weekend service was launched in January as part of a 50-day pilot aimed at relieving pressure on Bronglais and Glangwili Hospitals, both of which are struggling with some of the worst emergency department waiting times in the country.

But the funding ends this Sunday (March 30), and no extension has been confirmed—despite a surge of public support for keeping the centre open on Saturdays and Sundays. An online petition had attracted almost 1,500 signatures by Wednesday lunchtime.

Hywel Dda University Health Board confirmed the end of the pilot in a statement this week.

“From April, the urgent care centre will continue operating Monday to Friday from 8:00am to 6:00pm,” a spokesperson said. “Patients can walk in or call 01239 803075 to speak to a triage nurse before attending.”

The board said the weekend service had been well used, with 845 patients seen across the first seven weekends. Roughly three-quarters of those patients would otherwise have attended A&E.

In addition, the pilot supported a ‘Digital Ward’ approach, allowing 63 patients to be treated remotely over the past two months—something the board described as an example of “innovative care close to home.”

A formal evaluation of the weekend provision will take place following the conclusion of the full trial period.

Ceredigion MS Elin Jones also called for an urgent rethink.

“I strongly support the continuation of weekend services in Cardigan,” she said. “They’ve clearly helped reduce unnecessary A&E visits, and we need to build on that—not go backwards.”

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Health

Big rise in ambient gamma radiation in Wales, but Milford Haven remains stable

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MILFORD HAVEN is among several sites in Wales where ambient gamma radiation levels remained stable, despite the country recording the highest overall rise in such readings across the United Kingdom.

New analysis by environmental company SunSkips, using data released by the Department for Energy Security and Net Zero, shows that Wales saw an average increase of 11.11% in ambient gamma radiation this January — the highest of any UK nation.

Ambient gamma radiation refers to the background level of gamma rays naturally present in the environment. Gamma rays are a form of electromagnetic radiation, similar to X-rays but with higher energy. They originate from cosmic rays, naturally occurring radioactive materials in the soil, and gases such as radon. Human activity — including medical procedures, nuclear power, and certain industrial processes — can also contribute. While low levels of ambient radiation are expected and generally harmless, monitoring changes is important for assessing environmental safety and potential health risks.

While Milford Haven held steady at 0.12 µGy/h, several other Welsh sites recorded noticeable increases. Rhyl, in Denbighshire, experienced the sharpest rise at 11.11%, with radiation levels increasing from 0.09 µGy/h to 0.10 µGy/h. In Ceredigion, both Aberporth and Trawscoed saw increases of 9.09%, rising from 0.11 µGy/h to 0.12 µGy/h.

In contrast, St Athan in the Vale of Glamorgan showed the biggest decrease across Wales, with a 9.09% drop — down from 0.11 µGy/h to 0.10 µGy/h.

Other locations with no change included Mumbles Head (Swansea), Aberdaron (Gwynedd), Lake Vyrnwy (Powys), and Valley (Anglesey).

LocationNormal (µGy/h)Jan 2025 (µGy/h)% Difference
Rhyl (Denbighshire)0.090.10+11.11
Aberporth (Ceredigion)0.110.12+9.09
Trawscoed (Ceredigion)0.110.12+9.09
Milford Haven (Pembrokeshire)0.120.120
Mumbles Head (Swansea)0.090.090
Aberdaron (Gwynedd)0.100.100
Lake Vyrnwy (Powys)0.120.120
Valley (Anglesey)0.090.090
St Athan (Vale of Glamorgan)0.110.10-9.09

Looking at the broader picture, Wales leads the UK in gamma radiation increases:

RegionHighest % Difference
Wales11.11
Northern Ireland10.55
Scotland9.18
England8.98


Mat Stewart, Managing Director at SunSkips, said there are many misconceptions about radiation levels and nuclear waste. He said that while some nuclear waste is long-lived, modern waste treatment and deep geological storage mean it can be safely managed without posing significant danger to the public.

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Health

Welsh Government pledges to boost NHS and schools following Spring Statement

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First Minister says UK Government funding will help Wales tackle waiting times and support communities

THE FIRST MINISTER has welcomed a £1.6bn funding boost confirmed in the UK Chancellor’s Spring Statement – saying it will allow the Welsh Government to invest in health, education, and communities across the country.

In a measured response to the Chancellor Rachel Reeves’ economic update, First Minister Eluned Morgan acknowledged the difficult financial context but stressed that Wales stood ready to use the additional resources to deliver real improvements.

She said: “The Spring Statement confirms the £1.6bn boost to our funding for the next financial year and provides an additional £16m on top of that.

“Wales will benefit from a growing economy and interest rates that are going down.”

The statement comes after the UK Government outlined a package of spending plans aimed at restoring fiscal balance, including controversial cuts to disability benefits and warnings from the Office for Budget Responsibility about sluggish income growth and rising inflation in 2025.

Despite the uncertain national outlook, the First Minister said Wales remained focused on its priorities.

“Our commitments remain firm,” she said. “The confirmed boost to our funding from the UK Government for 2025-26 means the Welsh Government will strengthen our NHS, cut waiting times, support schools and help communities thrive – making real differences to people’s lives.”

She also confirmed that ministers in Cardiff Bay would now review the broader implications of the Spring Statement.

“We will now thoroughly assess the Spring Statement’s implications on our future spending plans,” she added.

The Welsh Government has already faced criticism over pressures on the health service and education, with local authorities calling for more support to deal with inflationary pressures and increasing demand.

While the funding uplift is welcome, public sector leaders are warning that tough choices still lie ahead, particularly given the impact of UK-wide welfare reforms and cost-of-living challenges facing Welsh households.

The Herald understands that ministers will meet next week to begin budget planning in light of the new figures.

To add some context, here is what Gus Williams, interim CEO at Chambers Wales South East, South West and Mid, said. He told The Pembrokeshire Herald: “As expected, there was not much in terms of new announcements in the Chancellor’s Spring Statement today. The OBR forecasts highlight economic concerns already familiar to most businesses in Wales. Inflation concerns have not yet disappeared and there are worries about business and consumer confidence.

“Infrastructure and housing falls within the remit of the Welsh Government and like the rest of the UK, Welsh businesses support the prioritisation of simplifying the planning system but are keen to see the proof of this with spades in the ground. The industrial strategy and increased defence spending we hope will have a positive impact in Wales where the manufacturing and defence industries have a significant presence. Infrastructure investments are proven to boost economic investment, and channelling more spending out of the civil service and directly into infrastructure and increasing the amount of funding available to Wales is also welcome, providing the right projects are chosen.

“It is difficult to see any significant improvement in confidence and investment driving economic growth without capital investment led by the government. The government remains bound by fiscal rules that I would argue ignore the economic impact of borrowing to fund capital investments. Part of the problem has been the lack of any robust return on investment analysis on government spending.

“Consumer confidence remains hamstrung by a two-tier economy. The success of healthcare, welfare, and employment reforms will hang on whether they manage to improve overall employment and wage growth; this will be a big test over the next 12 months. The government has been clear that this is how it expects to be judged in the long term.

“Business owners are facing significant headwinds, the full impact of which we are yet to see. The economy could break out of these headwinds but the government will need to lead the way – just cutting spending will not change much, reform needs to achieve change.

“Global trade remains the government’s other major challenge. At the moment the government is trying to balance its relationship with the US and EU and whether events will force them off the fence one way or another remains to be seen. With domestic demand static, growth may be dependent on how the global trade environment now evolves.”

From a business point of view, Lloyd Powell, head of ACCA Cymru/Wales, said: “This week’s announcements by the Chancellor are likely to be cautiously welcomed by Welsh businesses.

“Small businesses in particular will be pleased to have some breathing space on VAT, with the threshold increased slightly to £90,000. ACCA had called for this given the artificial brake on growth it represents for smaller businesses, combined with the knock-on impact to HMRC of dragging more businesses into this tax regime at a time when service levels are already at historically poor levels.  

“We welcome the commitment to further improvements to the R&D tax relief scheme, as well as plans to improve regulation in the tax advice market, to recognise the value of professional agents. 

“As well as the effects from the NI cut, VAT registration threshold increase, child benefit changes, alcohol and fuel duty freezes, the Chancellor announced that Wales will be allocated a ‘Barnett consequential’ of £170m. He also announced Levelling Up funding for Welsh projects – £10m for Venue Cymru and £5m for Newport. The Chancellor also announced a £160m deal for the UK government to purchase the site of the planned Wylfa nuclear site in North Wales. 

“The Chancellor announced the scrapping of the Furnished Holiday Lets scheme, which gives extra tax reliefs on properties being rented out to holidaymakers. There are more than 11,000 self-catering holiday lets in Wales, according to the Welsh Government’s latest list of properties paying non-domestic rates. 

“Whilst a welcome simplification to the tax system overall may boost the availability of rented accommodation locally, the removal of the short-term holiday let regime will be a blow for some. The Welsh Government has already introduced changes to make it harder for holiday lets to be exempt from council tax.”

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