Health And Social Care In Wales: How Is It Different And What Are The Challenges?

Health and social care in Wales are very different to other parts of the UK. Many things make Wales a unique country, especially its people and its geography. Both of these combine to bring health and social care challenges to Wales that other constituent countries of the United Kingdom do not face. The Welsh government and NHS Wales have made some massive improvements to healthcare in Wales since devolution, but there is still a lot of work to be done to raise the standards of care.

Why Is Healthcare In Wales Different?

The UK Labour Government of the late 1990s began the devolution of centralised powers from the UK to parliaments of the constituent countries. Responsibility for NHS Wales passed to the Welsh government in 1999, and since 2009 Wales has managed its healthcare through seven Local Health Boards (LHBs). These boards are headed by commissioners and representatives of healthcare providers and take an integrated approach to healthcare.

They deliver a full range of services, combining hospital care with mental health and welfare, GP and dental services, and even pharmacies and opticians. This contrasted with the healthcare structure in England until recently. Now, the UK plans to follow elements of the Welsh model, and remove the divisions between commissioners and providers to provide a more integrated healthcare service.

The seven LHBs and three Welsh NHS Trusts work together to provide an efficient healthcare system by using both data and public policy analysis to streamline services and reduce waiting times. By sharing resources the Welsh government has demonstrated that a higher standard of care and service can be offered in the UK without runaway expenditure.

The Welsh government sets healthcare policy and funding levels for Welsh NHS Trusts and LHBs. This influence is ultimately what makes NHS Wales different from the health services of the other nations of the United Kingdom. The Welsh people, through their representatives, have used their power to shape a health system that serves them and their needs.

What Role Does The Welsh Government Play?

The Director General for Health and Social Services, currently Judith Paget, is also the Chief Executive of NHS Wales. This is set to change soon after the government committed to establishing an NHS Executive for Wales. The original aim of this role was to centralise leadership and decision-making. This direction was taken in the wake of a Parliamentary Review of Health and Social Care in Wales.

This new department will be a strong executive centre for the service and is intended to be a role with a clearer distinction between healthcare and civil service responsibilities. This is to give NHS Wales stronger, national guidance and the role has the power to set targets for both the Trusts and LHBs. The new executive will work with them to raise the standard of healthcare in Wales.

Though the commitment to establishing an NHS Executive was made in 2019, the measure is still waiting to be implemented. Some independent observers are concerned that the new Executive office’s powers are already being diminished. Healthcare across the UK has faced some huge challenges in the last few years. The delay in the development of this office and how the Welsh government proceeds with its creation will determine how NHS Wales and other Welsh healthcare services recover.

Many in the Welsh healthcare industry are concerned that until the NHS Executive office comes online, healthcare in Wales will not move forward. More concerns were raised when the government released plans to implement a ‘hybrid model’ for the role. Independent organisations, including patient care groups, worry that the growth of NHS Wales and integrated healthcare will be stymied by this change in direction.

How Are Welsh Social Services Being Challenged?

Finding, training, and retaining staff is becoming incredibly challenging for Welsh social services. The level of skills and experience required for high-quality social care are increasing all the time, but human resources are dwindling. Shortages in staffing have led to a decline in the quality of care social services can supply, having a devastating impact on Welsh communities and patients.

Many external forces are affecting the staffing levels of social services in Wales. The economic challenges the whole world faces are straining workforces in many sectors. These same forces also create excess demand for social services. The Welsh government and the Local Health Boards and Trusts are caught between increasing demand and a reduced supply, which is squeezing their resources further.

Poor pay levels and working conditions are highlighted as reasons for the high vacancy rates in Welsh social services. Care workers of all kinds used to expect to be paid a premium on the salary of the retail and hospitality industries, but over the last five years, the gap has levelled. Without more investment in the people that make social services possible, the quality of care provided will continue to diminish.

What Challenges Does Healthcare in Wales Face?

In recent years, healthcare systems around the world have faced unique and once-in-a-generation challenges from the global pandemic of 2020. The response from Welsh healthcare helped to contain the spread of COVID-19, and save lives. Like many other healthcare services, NHS Wales is still recovering from the strain on funding and resources the pandemic caused.

With every crisis comes opportunity. Many within Welsh healthcare and in the government see the recovery from the pandemic as a chance to reform many aspects of NHS Wales. This could provide a better quality of service while reducing costs. There are systemic and workforce challenges to overcome that existed before COVID-19, and the outbreak highlighted them. With a more robust and reorganised staffing structure combined with stronger central leadership, Welsh healthcare can be better prepared for future pandemics and provide better outcomes for patients.

The Wales Centre For Public Policy recently completed an in-depth review of the Welsh healthcare services to identify areas for improvement and development as the pandemic-related stresses subside. Two of the key areas for improvement are leadership and decision-making. The failure to implement the NHS Executive before the pandemic is seen as a cause of service bottlenecks during the outbreak.

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Welsh healthcare providers struggled to react quickly to the early signs of the outbreak. The lack of centralised leadership prevented NHS Wales from being agile and able to shift resources to the areas hardest hit by COVID infections. Lessons learned in the pandemic have underscored the need for centralised executive powers from a focused role.

This is why the government’s plan to create a hybrid role was met with disappointment. NHS Wales and the Welsh people deserve a health service with clear lines of responsibility. Redefining the role of the NHS Executive and what authority it will have, increases an already long delay in its implementation. How NHS Wales handles current challenges and responds to stresses in the future will be determined by the powers and portfolio of the new NHS Executive when the office is finally opened.

The future of NHS Wales and Welsh social care will be uncertain until the role of the new NHS Executive is defined and filled. Devolution has empowered the Welsh health and social care services to set new standards of care in the UK, but this momentum is being lost while the Welsh government hesitates and shifts direction.