ALL local authorities in Wales should standardise payments for care home places, according to Care Forum Wales, the organisation representing the sector. The current system, where fees are set by individual councils, has led to stark discrepancies across the country, creating what the forum describes as a “postcode lottery”.

A significant variation in weekly charges for basic care has emerged between neighbouring counties, with some care home owners warning that the situation could force more closures. In two adjacent counties, the fees can differ by as much as £70 per week.

The Welsh government has acknowledged the issue, stating that its new National Office for Care and Support is considering measures “to bring about consistency”. However, it has also indicated that fee rates will continue to differ due to “local factors like land values for care homes”.

The Welsh Conservatives criticised the current approach as a “false economy”, arguing that social care and health services should not be competing for resources. Plaid Cymru echoed the need for change, calling for a “transformational change” in the health service.

Orme View care home in Llandudno, Conwy county, has seen its fees rise this year, following a decision by Conwy council to break away from the system where all councils in north Wales set their fees collectively. Instead, the council has adopted a new fee structure based on recommendations from an independent assessor, resulting in significantly higher payments.

Steffan Robbins of Orme View welcomed the change, calling it “an amazing, positive step forward.” Speaking to Politics Wales, he said, “Conwy have taken that step to really assess the true cost of care and make sure they deliver a fee that’s affordable to them, but also a fee that reflects the true costs that we’re seeing in the sector.”

In contrast, the Old Vicarage care home in Llangollen, Denbighshire, is receiving thousands of pounds less per resident each year compared to Orme View because it relies on the fees set by Denbighshire council. Although there has been an increase in fees this year, it remains substantially lower than the rates in neighbouring Conwy.

Currently, the fees for basic care in Conwy are £846 per week, while in Denbighshire they are £774. The disparity means that some care homes, like the Old Vicarage, are forced to charge residents additional top-up fees to stay afloat.

“It’s very disappointing,” said Bethan Mascarenhas, who runs the Old Vicarage. “As somebody who’s very invested in the work that they do, we really strive to give the absolute best level of care… Unfortunately, the divide between the fees will make that difference in what you can provide.”

A call for change

Care Forum Wales, the umbrella organisation for Welsh care homes, has warned that the current system is undermining facilities in areas where the fees do not reflect the actual costs. Chairman Mario Kreft emphasised the need for uniformity, stating, “The new National Office for Care and Support needs to ensure we have parity across Wales, that there is at least an understood basic level of funding across all local authorities and health boards. We’ve got to move away from a postcode lottery.”

Denbighshire council responded by asserting that it is striving to balance financial constraints while ensuring the sustainability of the care sector in the county. “We have worked hard to strike the delicate balance between navigating challenging financial constraints and ensuring that we are maintaining a sustainable future for the care sector in the county,” a spokesperson said. The council also noted that it has not seen evidence to suggest that differing fee rates are affecting the solvency of care homes in Denbighshire.

Speaking to BBC Politics Wales, Welsh Conservative MS Sam Rowlands urged the Welsh government to ensure that local authorities receive adequate funding to properly compensate care homes. “It’s kind of a false economy pitching social care against health services, because we know that there are hundreds and hundreds of beds in our hospitals at the moment which are blocked because people cannot access the care services that they need,” he said.

Plaid Cymru MS Mabon ap Gwynfor also called for a significant shift in the approach to care services. “We need to see a transformational change within the care service,” he said. “We need to see the Welsh government actually put this first and foremost as a priority… and to deliver that national care service so that care is free for individuals, that people working in the sector are paid properly, so that we know that our loved ones get that care.”

The National Office for Care and Support is currently exploring the possibility of introducing national fee methodologies to standardise care home fees. However, it has indicated that this does not necessarily mean a single national fee rate, as fees will still vary according to local factors such as land values for care homes.

The debate continues as stakeholders await the government’s next steps in addressing the inequalities in care home funding across Wales.

SENEDD Member Paul Davies has called for urgent action over statistics which show that 63.3% of patient pathways assessed as being at highest risk of irreversible harm are waiting beyond their target date for treatment in the Hywel Dada University Health Board area. The latest figures from the Welsh Government show that 11,295 patients in the Hywel Dda University Health Board area are at the highest risk of irreversible harm because of waiting beyond their target date for treatment.

Mr Davies said, “These statistics are extremely alarming and behind them are thousands of people living in west Wales at risk of irreversible sight loss because they are waiting too long for their appointments. Not only are many of these patients in pain and discomfort, but some have also lost jobs because of their deteriorating eyesight.  

“We need action as a matter of urgency and I urge the Welsh Government to endorse the National Clinical Strategy for Ophthalmology and prioritise its implementation. Eye care services are still under huge pressures, its infrastructure requires significant investment and there are serious recruitment and retention issues. Therefore, it’s vital that this is prioritised immediately – as each month that passes without a commitment to improve eye care will result in more and more people being added to waiting lists.”

THE NHS in Wales continues to navigate a complex landscape of challenges and achievements as it strives to deliver quality healthcare to its population.

Recent reports highlight both the pressures faced by the system and the initiatives underway to address them.

Healthcare professionals across Wales have expressed concerns over increasing workloads and resource constraints. Hospitals are grappling with high patient numbers, leading to extended waiting times for elective surgeries and specialist consultations. According to figures released by NHS Wales in September 2023, the number of patients waiting for treatment exceeded 750,000—a record high.

Emergency departments have reported surges in attendance, putting additional strain on staff and facilities. In August 2023, A&E departments across Wales recorded their busiest summer on record. Dr. Rachel Davies, an A&E consultant at the University Hospital of Wales in Cardiff, commented, “We’ve seen unprecedented numbers of patients this year. Our staff are working tirelessly, but the demand is overwhelming.”

In rural areas like Pembrokeshire, the situation is compounded by geographical hurdles. This newspaper has recently highlighted concerns over ambulance response times in the county, noting that residents in remote locations often face longer waits for emergency services. Local resident Sarah Jenkins shared her experience: “When my mother fell ill, it took over an hour for the ambulance to arrive. In critical situations, every minute counts.”

A shortage of medical personnel remains a significant issue. Recruitment and retention of doctors, nurses, and allied health professionals are ongoing concerns. The Royal College of Nursing Wales reported in October 2023 that there are over 1,800 nursing vacancies across the country. Many professionals cite burnout and limited resources as factors influencing their decision to leave or avoid joining the NHS workforce in Wales.

Eluned Morgan, the Welsh Minister for Health and Social Services, acknowledged these challenges during a recent Senedd debate. “We are acutely aware of the staffing shortages and the immense pressure our healthcare workers are under,” she said. “Addressing these issues is a top priority for the government. We’re investing in training and recruitment to bolster our workforce.”

Opposition parties have called for more decisive action. Plaid Cymru’s health spokesperson, Rhun ap Iorwerth, stated, “The staffing crisis in our NHS is not just a numbers problem; it’s about the wellbeing of those who dedicate their lives to caring for others. We need urgent measures to support and retain our healthcare professionals.”

In response to the mounting pressures, the Welsh Government has increased funding for the NHS, aiming to improve infrastructure and service delivery. The 2023 budget included an additional £425 million allocated to health and social services. Investments are being made in modernising hospitals, expanding digital healthcare services, and streamlining patient care pathways.

The then First Minister Mark Drakeford addressed the situation during a press briefing in September 2023: “Our commitment to the NHS is unwavering. We are working closely with health boards to tackle waiting times and ensure that everyone in Wales has access to the care they need.”

The government has also launched targeted recruitment campaigns and enhanced training opportunities to bolster staffing levels. “We are investing in our future workforce,” Eluned Morgan added. “By supporting education and providing incentives, we aim to attract new talent to the NHS and retain our valued staff.”

Despite the hurdles, there are success stories emerging within the NHS in Wales. Community-based health programmes are making strides in preventive care, focusing on wellness and early intervention to reduce the burden on hospitals. For instance, the “Healthy Pembrokeshire” initiative aims to promote healthy lifestyles through local events and education.

Telemedicine initiatives have been accelerated, particularly in response to the COVID-19 pandemic, enhancing access to care for those in remote areas. Dr. Gareth Thomas, a GP in Ceredigion, noted, “Virtual consultations have been a game-changer for patients who live miles away from the nearest clinic. It has significantly improved access to care and reduced travel times.”

Healthcare professionals are also embracing collaborative approaches, with multidisciplinary teams working together to provide comprehensive care. These efforts aim to improve patient outcomes and increase efficiency within the system.

Patients have offered mixed feedback on the state of the NHS in Wales. While many praise the dedication of healthcare workers and the quality of care received, others express frustration over delays and difficulties in accessing services.

John Evans, a patient awaiting hip surgery, shared his experience with Wales Online: “I’ve been on the waiting list for over 18 months. The pain limits my mobility, and it’s affecting my quality of life. I understand the pressures the NHS is under, but the delays are disheartening.”

Advocacy groups are calling for increased transparency and patient involvement in decision-making processes. The Patients Association Wales has urged the government to “prioritise patient voices in policy development and healthcare planning.”

The Welsh Conservative health spokesperson, Russell George, commented, “Patients are bearing the brunt of systemic failures. The Welsh Government must take responsibility and implement effective strategies to reduce waiting times and improve service delivery.”

The NHS in Wales stands at a critical juncture. Balancing immediate demands with long-term strategic planning is essential to address the systemic issues at hand. Continued investment, innovative solutions, and collaborative efforts between the government, healthcare providers, and communities are key to strengthening the NHS for future generations.

As the nation navigates these challenges, the resilience and commitment of its healthcare professionals remain a beacon of hope. The path forward will require concerted efforts to ensure that the NHS can continue to uphold its founding principles of providing comprehensive, accessible healthcare to all.