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Health

Welsh NHS crisis deepens

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WALES’s Health Minister Eluned Morgan has warned that the health and social care system in Wales is currently under ‘extraordinary pressure’.

Significant challenges caused by COVID outbreaks within hospitals limiting available bed capacity, high levels of COVID in the community, staff sickness absence and blockages in patient flow through hospitals leading to difficulties discharging patients have put the sector under strain.

These issues have been exacerbated by a recent increase in levels of demand.

People in Wales are being urged to ‘help us, help you’ by accessing the NHS 111 Wales website and its symptom checkers, helping to ensure they access the right care in the right place the first time.

This will help reduce avoidable delays to care and support more acutely ill people to be treated most appropriately.

It comes after the Aneurin Bevan University health board declared a business continuity incident yesterday, also known as a Black alert, in light of unprecedented pressures at its Grange University Hospital and other sites.

This is the highest level of escalation available and indicates the severe pressure being experienced by our health and care services.

Previous health minister Vaughan Gething rushed through the Grange’s opening before last May’s election despite understaffing and without all facilities for its operation being ready.

Hospital sites across Wales are under extraordinary pressure, which has affected the timely delivery of care.

This has resulted, at times, in lengthy ambulance patient handover delays, limits on ambulance capacity, increased waits for admission from emergency departments to a hospital bed and longer waits for discharge home once treatment has been completed.

Measures have already been taken across all health board areas to relieve pressure to ensure patients can continue to receive the care and treatment they need in a safe and timely manner.

To manage the situation in the Aneurin Bevan University Health Board area, where The Grange University Hospital is based, all non-essential activities have been cancelled, with clinical and non-clinical senior colleagues re-prioritising their workload accordingly to manage the position across the Gwent region.

Health Minister Eluned Morgan said: “The health and social care system in Wales is currently under extraordinary pressure, and we would strongly urge anyone seeking care to make sure they access the right care in the right place, whether that’s through ‘help us, help you’, access to the NHS Wales 111 website or urgent and emergency care.

“We have been open about the challenges that NHS Wales and 999 and Emergency Departments are under. This is not a unique situation in Wales; health services across the UK face similar challenges.

“Our priority is to ensure the safe and efficient delivery of healthcare services. Anyone with a serious or urgent need for hospital treatment and those who have ‘a life-threatening illness or serious injury’ should still attend the emergency department.

“Those who have a less urgent need or could access the treatment they need at an alternative setting can help reduce pressure by choosing the right service.
“The public can also help by supporting the timely discharge of their family members when they are ready to leave hospital. 

“If you have a relative or loved one in hospital who is well enough to go home but is waiting to be discharged with home care and community health support, you MAY be able to help them to get home more quickly if you and your family are in a position to support them at home.”

THE LOCAL PICTURE

Emergency and unplanned care services in community and hospital settings are under unprecedented pressure across the Hywel Dda UHB area on Wednesday, March 30.

The Board’s Director of Operations, Andrew Carruthers, said: “We are dealing with a combination of high numbers of attendances, particularly in our Emergency Departments, and challenges in health professional staffing due to COVID-19. 

“Our GP practices and hospitals are busy, and we still need to follow specific requirements for the safe treatment of those patients with COVID-19 and those without.

“We are working with our local authorities as there are difficulties in discharging some patients due to similar staffing challenges the social care sector faces. This means we have very few beds to accommodate patients who need admission.

“Our teams are helping patients by their clinical priority, but this does mean that in some cases, waits in our Emergency Departments are hours long and far more than what we would strive to deliver.

“If you need medical help, please think carefully about the services you choose.” 

If you are unwell and unsure what to do, you can visit the online symptom checker or call NHS 111 if you are unsure what help you need.  

Only attend an Emergency Department if you have a life-threatening illness or serious injury, such as: 

• Severe breathing difficulties 
• Severe pain or bleeding 
• Chest pain or a suspected stroke 
• Serious trauma injuries (e.g. from a car crash) 

If you have a less serious injury, please visit a Minor Injury Unit. They can treat adults and children over 12-months of age with injuries such as 

• Minor wounds 
• Minor burns or scalds 
• Insect bites 
• Minor limb, head, or face injuries
• Foreign bodies in the nose or ear

Minor injury or walk-in services to serve Pembrokeshire are located at Cardigan Integrated Care Centre, Tenby Hospital, and main acute hospitals.

Many community pharmacies can also provide walk-in, common ailment or triage and treat services without an appointment.

However, due to Covid infection, several community pharmacies in Pembrokeshire are already closed to the public, leaving patients with Hobson’s Choice of where to go.

Suppose you have an inpatient relative waiting for a formal care package. You may be able to offer support and care on a short term, temporary arrangement, or you might want to consider whether your loved one could be supported in a temporary residential or nursing care setting. 

If you feel that this is an option you could consider, please speak to the ward manager or your social worker to explore further and see what support is available.

Health

Junior doctors secure strike extension in pay negotiations with WG

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BMA Cymru Wales has confirmed a positive development in its pay negotiations announcing that Junior doctors have secured a three-month extension to their overwhelming strike mandate.

This means that junior doctors in Wales now have the right to enact industrial action over their pay until 17 September 2024 instead of 17 June when the mandate was due to run out.

Recognising the strength of feeling amongst junior doctors and the overwhelming 98% vote by members in favour of industrial action back in December 2023, employers have agreed to honour this extension to allow talks with the Welsh Government to continue.

Co-chairs of the Welsh Junior Doctor Committee Dr Oba Babs-Osibodu and Dr Peter Fahey said of this development:

“We are pleased to be able to secure an extension to our overwhelming strike mandate. Whilst we hope to put an end to our pay dispute through pay negotiations by reaching a credible deal and restoring our pay, it was important to secure more time for our mandate.

“The extension allows us to focus on talks but also provides us with the scope to get organised and enact our legal right to strike should we need to. This is about honouring the emphatic mandate of our members.

“Doctors have experienced real terms pay cut of almost a third since 2008. They voted overwhelmingly to put an end to the devaluing of their service, they know they are not worth a third less than their predecessors and they know the time is now to stick up for the profession and turn the tide of the continued erosion of their pay once and for all”.

The Welsh Government and NHS employers have agreed to the extension as part of ongoing pay negotiations where all parties hope to reach an end to the pay dispute with junior doctors, SAS doctors and Consultants in Wales.

Last month, BMA Cymru Wales announced it was suspending forthcoming industrial action for Consultants and SAS doctors and putting plans on hold to announce more strike dates for junior doctors to allow pay negotiations to take place*.

The decision to enter pay negotiations was based on a significant proposal from the Welsh Government to form the basis of talks to end the pay disputes with all secondary care doctors including Consultants, SAS, and Junior doctors, with the aim of reaching deals which can be taken separately to their respective members.

In August last year, the BMA’s committees representing secondary care doctors in Wales voted to enter separate trade disputes with the Welsh Government after being offered another below inflation pay uplift of just 5% for the 23/24 financial year. SAS doctors on some contracts were offered as little as 1.5%. This was the lowest pay offer any government in the UK offered and less than the DDRB, the pay review body for doctors and dentists, recommended last year.

As part of their disputes, SAS doctors, consultants and junior doctors carried out successful ballots for industrial action. Since then, junior doctors have taken part in 10 days of industrial action since January this year.

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Community

Plea to save at-risk Anchorage day care centre

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AN ONLINE plea to save a Pembrokeshire day centre from being closed has been lodged with the county council.

The Anchorage Day Care Centre in Pembroke Dock has been a “safe and happy place” for adults with learning difficulties and additional needs for decades.

In more recent years it has expanded to support elderly dementia sufferers.

But now the centre is expected to close, with services instead being offered elsewhere in the county, including Haverfordwest and Milford Haven.

A series of engagement events have taken place at The Anchorage recently, outlining the reasons and the options in continued service.

One parent, who wished to remain anonymous, said: “The parents and carers are all very upset at the way we have been treated, kept in the dark and then presented with what is a fait accompli to close the Anchorage, while at the same time going through the motions of a ‘consultation’ with us.

“The clients at The Anchorage have friendships with each other and staff going back decades in some cases.

“One young woman who attends ran out of the first meeting sobbing when she was told it was going to close. Another, at the second meeting, tried to address the meeting but was so chocked up at the thought of not seeing her friends anymore she could hardly speak.”

She added: “The Anchorage has been a respite in the day for parents and a safe, happy place for the clients.

“Everyone feels that the county council is not considering the feelings of the clients, most of whom are upset and frightened by change to their routine.”

Another person raising concerns said: “The centre is set to close as early as next month – meaning the sudden retraction of a service which, for many families in the area, is nothing short of a lifeline.

“I’m not sure PCC understand the gravity of the impact that closing the centre will have on the lives of many people, particularly the customers, some of whom may not understand or cope well with such a total upheaval of the familiarity of their daily routine.

“It’s so upsetting that the people who will be most affected by the closure of the centre are as much a part of the Pembrokeshire community as anybody else that the council claims to represent, and yet in this decision, I feel they’re not being seen as such.”

Since then, an online e-petition, on the council’s own website has been launched calling for it to stay open.

It says: “The centre provides day-care support to a number of vulnerable adults with varying levels of disability who are unable to process, and understand, the implications of such a decision.

“Some of those attending the centre have been doing so for over 20 years and continuity is a vital part of their lives. Removing this service will have nothing other than a huge detrimental impact on their health and mental wellbeing.”

The petition has attracted 284 signatures to date.

A Pembrokeshire County Council spokesman said: “Following the engagement sessions held with families and service users regarding the future of the centre on April 10 and 17 at the Anchorage, families said that they would like to maintain the Anchorage Day Centre and explained that they would write to the council in order to ask for the decision to be overturned.

“People who attend the service will be offered alternative care, all service users are currently having their individual care needs assessed by social work teams to fully understand which other services best meet those care needs.”

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Health

Dental services ‘facing collapse’ in Wales

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DENTAL services are at risk of catastrophic collapse, with people resorting to “DIY dentistry” and pulling their own teeth with pliers, the Senedd heard.

Peter Fox warned that NHS dental services are seeing rapid decline following the Welsh Government’s introduction of a new contract in 2022.

He told the Senedd: “These contracts don’t work for dentists, nor do they work for patients,” as he highlighted a 60% fall in the number of NHS dental posts compared with 2021.

Echoing concerns raised by the British Dental Association, the Conservative MS said dental services face potential catastrophic collapse due to the contract reforms.

Mr Fox, who represents Monmouth, cautioned that patients are being left with a choice between years’-long waiting lists or paying hundreds of pounds for private care.

He said: “This lack of accessibility has led people to drastic action – from harrowing stories of people pulling out their own teeth with pliers or people being forced to take 200-mile round trips to get dental appointments. Clearly, this is just simply unacceptable in the 21st century.”

Leading a debate about primary care on April 24, Mr Fox warned GPs are also struggling due to a lack of contract funding, which is not uplifted in line with rising costs and pay uplifts.

He told MSs some GPs are having to pay staff and utility bills out of their own pockets, with practices forced to withdraw more and more services.

The Conservative said some constituents face 50-mile round trips and 50-week waits for services in hospitals that were previously carried out routinely and timely in GP practices.

Mr Fox, who led Monmouthshire council for more than a decade before being elected to the Senedd in 2021, urged the Welsh Government to urgently review GP and dental contracts.

Eluned Morgan told the chamber the majority of contacts with the NHS are in primary care – with up to one-and-a-half million contacts a month in a population of three million people.

Wales’ health secretary recognised the extreme pressure on practices, saying the contract last year provided a 5% uplift not just to GPs but also staff who work in their surgeries.

She said: “We want to reform the dental contract on a preventative basis, responding to risk and need, and we have introduced up to 300,000 appointments to new dental patients.”

Baroness Morgan, who is married to a GP, stressed the importance of other professionals in the community, such as pharmacists and opticians, to the preventative agenda.

She said most pharmacies in Wales provide a free service for 27 common ailments, helping to reduce pressure on GPs and other parts of the healthcare system.

During first minister’s questions on April 23, Sian Gwenllian said many of her constituents are unable to access public dental services – “an entirely unacceptable situation”.

The Plaid Cymru MS for Arfon raised concerns a new dental academy in Bangor closed its books to NHS patients despite promises it would help tackle a lack of public services.

Sam Rowlands, the Conservatives’ new shadow health secretary, said far too many people across north Wales do not have access to an NHS dentist.

He raised comments from Russell Gidney, chair of the Welsh general dental practice committee, warning of a rise in “DIY dentistry” due to a lack of proper access.

Vaughan Gething said the Welsh Government is committed to reforming the dental contract to unlock capacity and access to NHS services is one of the health secretary’s top priorities.

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