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Health

Welsh cancer care in peril as workforce crisis escalates, warn radiologists

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THE ROYAL College of Radiologists (RCR) has issued a stark warning about the escalating workforce crisis in Wales, revealing alarming shortfalls in clinical radiologists and oncologists.

Two new reports highlight a dire situation: Wales faces a 34% shortfall in clinical radiologists and a 12% shortfall in clinical oncologists. Without immediate action, these shortfalls are projected to rise to 28% and 38%, respectively, by 2028, the largest in the UK. Additionally, nearly a quarter (24%) of clinical oncology consultants in Wales are expected to retire in the next five years, compared to the UK average of 18%. Currently, trainees make up 29% of Wales’s clinical oncology workforce, slightly below the UK average of 32%.

Patient safety is at risk due to the critical shortage of radiologists. Wales has only 6.1 radiologists per 100,000 people, the lowest ratio among the four nations. All clinical directors in Wales report that they lack sufficient radiologists to provide safe and effective patient care. Cancer centres are experiencing routine delays in starting treatment and are struggling to manage increasing demand, relying heavily on goodwill, insourcing, and locums. Such delays are critical for cancer patients, as each month’s delay in treatment raises the risk of death by approximately 10%.

Despite the implementation of the Cancer Improvement Plan for Wales a year ago, the workforce crisis continues to worsen due to insufficient training and retention efforts. Hospitals are struggling to meet patient demand, and this issue is one of the most pressing challenges that the UK governments must address urgently.

The reports also reveal significant regional disparities in access to cancer care across Wales. Rural areas are the hardest hit. South West Wales has 7.4 clinical oncologists per 100,000 older residents, South East Wales has 6.6, but North Wales lags behind with just 5.3. North and West Wales suffer from the UK’s largest shortage of clinical radiologists, with London having twice as many radiologists per 100,000 people. This disparity leads to faster imaging test results and cancer treatment initiation in some regions, causing significant delays and increased anxiety in others.

An anonymous consultant stated, “I can no longer defend the NHS as an exemplary healthcare system. We are all failing and in so doing failing our patients.”

The RCR has written to the cabinet secretary, warning that without immediate intervention, Wales risks undoing decades of progress in cancer care. The RCR demands urgent investment in workforce development to ensure patients are not left waiting for a diagnosis and can begin lifesaving treatment promptly. They urge the next government to collaborate with the NHS to outline a plan to recruit, train, and retain clinical oncologists and radiologists, ensuring workforce stability for future generations.

Dr Katharine Halliday, RCR President, said, “Today’s reports lay bare a harsh reality: the crisis in Wales’ radiology and oncology workforce is jeopardising patient health. Despite our commitment to providing the best care, severe staff shortages are significantly impeding our efforts. We simply do not have enough doctors to safely manage the growing number of patients, and this issue will worsen as demand rises and more doctors leave the NHS. The immense strain on an overburdened system, coupled with exhausted staff and increasing demand, creates a toxic mix for the healthcare system in Wales.

“Urgent action from the governments of all four nations is essential. We must prioritise recruiting and training more doctors and implement strategies to retain our current workforce. Time is critical; doctors are working under extreme stress and are deeply concerned for their patients. We’re calling on the governments of all four nations to reset the system, save our NHS, and ensure that patients receive the quality care they deserve.”

Health

‘We are not for sale’ – Young people back plan to remove profit from care

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FOUR remarkable young people gave evidence to the Senedd’s health committee about their experiences of Wales’ social care system, supporting plans to stamp out profiteering.

Mark Drakeford asked the witnesses if they agreed with the principle of the health and social care bill, which would remove profit from the care of looked-after children.

Elliott James told the former first minister – who introduced the proposal while leading the Welsh Government – that for every £10 given for a child in care, £3 is taken away in profit.

He said one relatively standard residential placement can cost as much as £5,000 a week, with support workers paid a “shockingly” low amount.

Elliott stressed: “At the moment, companies are profiting off us and we are not for sale.”

Joanne Griffith similarly said: “We are not in the care system for people to profit off us – we don’t choose to go in the system, the system chooses us.

“Why should people be able to gain money … and spend it on whatever they want when in actual fact the money should be going to the young people, so that we can thrive?”

She added: “Put yourselves in our shoes, you probably wouldn’t want to be profited off.”

Rhian Thomas and Rowan Gray wholeheartedly agreed with the principle. But Rowan raised concerns for-profit providers “could end up packing up and going elsewhere”.

Elliott raised concerns about children being placed a long way from home, saying: It’s not just about the profit, it’s about the care of young people as a whole.

“A lot of young people are being let down currently.”

He said: “Moving a child hundreds of miles away isn’t always suitable….

“These placements can’t commit to contact, they can’t commit to free time so that leaves us not being able to see our family, not being able to go and see our friends.”

He warned that placements for children and young people with severe mental health problems are more than likely to break down because carers cannot cope.

Elliott said: “Unfortunately, the system thinks as soon as we enter care, all of our problems have been solved. They haven’t. We are still deeply traumatised young people who need care, love and support.”

While recognising the need for emergency placements, Elliot raised concerns about children moving from one to the next until a suitable placement is found.

He asked: “Why can’t we be placed into a suitable placement the first time around?”

Elliott told the Senedd some young people are “placement hoppers”, going to as many as 10 or 20 different placements in one week.

He said he was given only an hour-and-a-half notice before going into care and nobody was trained to really understand his autism.

“I was always left to suffer by myself because nobody knew how to help me,” he said, warning that symptoms of autism were treated as a behavioural issue.

Rhian stressed the importance of keeping siblings together and support for young people transitioning into care or adulthood.

She told Senedd members: “When you first come into care that’s the hardest part of it all.”

Rowan said it is vital to match the children going into care with the right foster carers.

“My last placement was with some people that were in their 60s,” he said. “When I was younger, I had a lot of energy and I was always wanting to do something.”

He told committee members the foster carers did the best they could but he wanted to build memories and they were sometimes not able to take part in activities he found fun.

Rowan was placed “out in the middle of nowhere” more than 10 miles from home.

“I didn’t have anyone around my own age who I could build friendships with,” he said.

Calling for more accountability, he told the Senedd: “If my local authority had actually done what they said they were going to do, I wouldn’t be sat here.

“I would be currently in Bristol living with my mother. Because there was no accountability … they went back on their word … and I ended up in long-term foster care.”

Joanne raised the importance of stability and continuity of care.

She told the committee: “It’s really important that we have a placement that we know we can stay in permanently and we’re not going to be moved within 24 hours … or a week.”

Joanne added: “We need a placement that we can call home.”

She called for compulsory training around mental health and disability, so “we know if we have an issue we can go to the foster carers and we’re not going to get stigmatised for it”.

Joanne also called for more unannounced visits to build up a more accurate picture.

The health committee is scrutinising the bill, aiming to report back to the Senedd in October, ahead a vote on the general principles with amending stages to follow.

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Health

Senedd backs call for more dentists in Wales

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THE SENEDD called on the Welsh Government to increase the number of training places for dentists amid warnings about “dental deserts” across the country.

Siân Gwenllian led a cross-party debate on dentistry training, with the Conservatives and Lib Dems joining forces with Plaid Cymru to amplify concerns about poor access to services.

Ms Gwenllian said a shortage of dentists exacerbates Wales’ “three-tier” system, with none of the practices in her Arfon constituency taking on new NHS patients.

She said: “A three-tier system where some are fortunate to access an NHS dentist, others can pay to go privately and the third tier, unfortunately, are those who can’t access NHS dentistry and can’t afford to pay to go privately.

“I don’t have to outline the problems that emerge for those in the third tier. Members are only too familiar with horrific stories about sepsis and do-it-yourself dentistry.”

Ms Gwenllian told the chamber, or Siambr, a common-sense solution would be to increase the number of university training places.

“But, to the contrary, the government sets a cap on the number of places that can be provided in our only school of dentistry in Cardiff – an annual cap of 74 places,” she said. 

The former councillor and journalist criticised a new dental workforce strategy, saying it does not commit to any specific increase in educational or training provision for dentists.

Pointing to a Tory commitment to a 24% increase in undergraduate places in England, she said: “Unfortunately, the party of Aneurin Bevan hasn’t shown the same ambition.

“And it is depressing and it’s a stain on Wales that the ability of a number of our constituents to access dentistry is reliant on their ability to pay.”

The Plaid Cymru politician argued having one school of dentistry in south Wales will never be sufficient to meet the needs of the whole country.

Sam Rowlands, the Conservatives’ shadow health secretary, said provision in north Wales is “simply not good enough” as he raised concerns about “dental deserts”.

He agreed that 74 places a year is not enough to plug the gap as he echoed calls for a “fully funded and fully functioning” dental school in his region.

Carolyn Thomas, who also represents North Wales, said people across the UK are struggling to access NHS dentists, with nine in ten not accepting new patients.

The Labour member recognised Wales-specific challenges on recruitment and retention, but pointed to progress with the dental academy in Bangor.

She told the chamber Labour has a fully costed plan to “rescue” dentistry at a UK level which will lead to much-needed consequential funding for Wales.

Mabon ap Gwynfor, Plaid Cymru’s shadow health secretary, raised concerns about a “failure to retain dentists and an even greater failure to train new dentists”.

Mr ap Gwynfor said only eight people from Wales got a place on Cardiff’s dentistry course last year, with only about half of the wider annual cohort choosing to stay in Wales.

Rhys ab Owen criticised a lack of data, saying: “It’s astonishing that we can’t say here and now in the Senedd how many people are waiting to see a dentist under the health service.”

Mr ab Owen raised a constituent’s concerns about their son, who was referred aged 11, having to wait nine years until he is 20 for orthodontic treatment.

The independent, who represents South Wales Central, said: “My constituent’s son has experienced bullying, his confidence has been knocked and his self-esteem damaged.”

Eluned Morgan told the July 3 debate that NHS dentistry has been a key priority since she became Wales’ health minister four years ago.

Providing an update on the recommendations of a 2023 health committee report on dentistry, Baroness Morgan said work on an all-Wales central waiting list is under way.

The health secretary reiterated that the key aim of dental reforms was new patients who have historically struggled to get access to NHS dental care.

Baroness Morgan said 500,000 people who had not received NHS dental care for more than four years have gained access since the reforms restarted in April 2022.

She said: “It’s interesting to note that an incoming Labour Government is also planning to deliver new NHS appointments, but proportionally we’re streets ahead of where the UK Tory Government was in terms of NHS access by new patients.”

Turning to dental training places, she stressed the need to take a “long-term evidence-based view” and be careful not to “over-focus” on dentists.

Baroness Morgan, a former member of the European parliament, said any increase would be difficult due to financial challenges and a lack of spaces at Cardiff’s dental school.

She said a second school would be the best option but warned: “That would mean a great deal of investment and financial pressures don’t allow that at present.”

However, she encouraged a joint proposal from Aberystwyth and Bangor universities.

The motion – which was co-submitted by Ms Gwenllian and Jane Dodds, the Lib Dems leader in Wales – was agreed with 29 for, none against and 15 abstentions.

Seven Labour backbenchers voted in favour.

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Education

New guidance on restrictive practices in healthcare, social care and education

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A SET of new resources aimed at reducing the use of restrictive practices in healthcare, social care and educational settings has been welcomed by the Minister for Social Care.

The Reducing Restrictive Practices Framework provides advice to those who work with children and adults across relevant settings and services.

The Framework aims to reduce the use of restrictive practices, also known as restraint, used on people of all ages and on those with additional learning needs.

The set of new resources to support the Framework have been developed by the Welsh Government in partnership with the Restraint Reduction Network and Improvement Cymru. The resources are based on the lived experiences of those affected.

They include an animation produced and written by people with a lived experience, an explainer document, and a poster.

The animation depicts the eight types of restrictive practice; physical, chemical, mechanical, enforced isolation, psychological, cultural, surveillance and blanket restrictions.

As well as the animation, the explainer and poster aim to support discussion and increase public knowledge.

Minister for Social Care, Dawn Bowden, has welcomed the new resources which aim to reduce the use of restrictive practices in relevant settings for people of all ages.

Speaking ahead of the launch of the new resources, Minister for Social Care Dawn Bowden said: “We know that restrictive practices can have a negative impact on the people they are used on, as well as those who implement and witness them”.

“We hope this new set of awareness raising resources will reduce the use of restrictive practices in the future, and increase knowledge of the harm they can cause.”

A webinar hosted by the Restraint Reduction Network in partnership with Welsh Government and Improvement Cymru has been planned for 24 July 2024 to officially launch the new resources.

Ben Higgins, Restraint Reduction Network CEO, said: “We are delighted to support the launch of the Welsh Government’s new resources for practitioners working in health, care and educational settings, created as part of the Reducing Restrictive Practices Framework.

“We hope that this coproduced animation increases understanding of restrictive practices – what they are, the harm they cause and how to reduce and prevent them – supporting practitioners to reduce the use of restraint in Wales and make a real difference to people’s lives.”

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