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Faster changes to Wales' health and care system urged

Getty Images Elderly careGetty Images
The biggest challenge is caring for an ageing population in Wales

The health and social care system in Wales will not be sustainable in the future in its current form, a team of independent experts has warned.

Change to deliver major NHS and care improvement is urgently required - and at a much faster pace, they said.

New ways of caring for older people should be a priority because of an ageing population, the experts added.

The interim report was commissioned by the Welsh Government. Detailed findings are expected later this year.

Dr Ruth Hussey, the former chief medical officer for Wales, is chairing the panel of nine experts from across the health and social care field.

It was set up by Health Secretary Vaughan Gething last November, with cross-party support, to look at how health and social care needs to be delivered in future.

It says the case for change is "compelling" but we need to "speed up" how the NHS adapts to changing needs and how it can operate in a more joined-up way.

Among the findings are:

  • The scale of challenges mean the system is becoming unstable, which cannot be resolved by small, step-by-step changes. There is an urgent need for service reform - including not just where care is delivered but how and by whom.
  • Major structural changes are not needed but instead concentrate on good examples of working on the ground which can be "scaled up rapidly" - with integrating health and social care support for older people a priority.
  • New skills and career paths for workers need to be planned on a large scale now - and current workforce shortages which inhibit change need to be addressed.
  • Many in the NHS agree on the case for change but there is less clarity on how to bring this about. It also needs to be far faster.
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Why is change needed?

The core of the challenge is our changing and ageing population.

Wales has the fastest growing proportion of older people in the UK - by 2039 there will be 44% more people aged over 65 compared to 2014.

The proportion of people living beyond 80 is also growing.

This is all likely to mean a much greater demand for care.

Over the same period there is expected to be a 5% relative decrease in the number of working age adults - which could mean less money will be collected in tax and a smaller pool from which to draw the future health and social care workforce.

Last chance saloon for the Welsh NHS? Prof Sir Mansel Aylward says changes must be made

One of the panel, Prof Sir Mansel Aylward, chair of the Bevan Commission, said: "The demographic time bomb has gone off - what I'm worried about are the salvos coming in over the next few years which could make it worse."

He said he believes efficiencies were still possible but facilities and services were being stretched and change was necessary.

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Bettws, Bridgend
In Bridgend, work is already under way to allow more elderly people to avoid hospital and be helped in their own homes

The panel will now work on putting together examples of what is already working well in practice and which can be applied across Wales.

Work in Bridgend has already caught its eye. Over the last two years, there has been very close working between the health board, council social services and the private and voluntary sectors - aimed at keeping as many elderly people out of hospital as possible.

It includes a tele-care scheme, which provides various alarms and detectors in 2,000 homes, connected to care support.

'Excitement'

Council leader Huw David believes it can actually save money further down the line.

"We've seen a steady decline in over-70s admitted to hospital in Bridgend - keeping people in their own homes when it's safe and in their interests," he said.

Dr Hussey said she believes there is a "real appetite" for change and they will learn lessons from within local communities and internationally.

Also on the panel is Prof Don Berwick, a leading American healthcare administrator in the Obama presidency. He said it was about better use of resources and Wales' size puts it in a position to benefit.

"If you really want to create better results for the population then you have to change," he told BBC Wales.

"Now that is uncomfortable and takes leaders who can help everyone get into the mode of learning and the excitement as we develop new systems.

"But if we keep on doing what we're doing, we will get the same results and we can do better than that."

A final report outlining more detailed recommendations is expected to be completed by the the end of the year, which according to the panel must lead to "prompt and tangible action", in contrast, it suggests, to previous reviews.