NHS 75: Rapid increase in staff needed, Welsh chief says

The head of the NHS in Wales, Judith Paget, has acknowledged the need for "a rapid increase in the number of staff", as well as fast-paced change.

She also would not rule out withdrawing care until patients made lifestyle changes to improve their health.

The chief executive said there was a plan to build up numbers "over time" and recent strike action highlighted the need to look after existing staff.

Ms Paget spoke as the service marks its 75th anniversary.

On the issue of withdrawing care due to lifestyles, she said: "If there is good evidence to think about what that looks like I think that is a possibility.

"We know that if people are obese, their ability to respond well to surgical procedures and recover well is compromised. What we want to do is to support people to lose weight before they have their surgical procedure."

But she was clear that she "would struggle with the concept of refusing people treatment on the basis of some of their lifestyle choices".

Ms Paget acknowledged the need for the service to change as it faced a growth in demand for services, with referrals alone having gone up 13% in the past year.

That is set against a backdrop of about 5,000 vacancies, according to Stats Wales, which also admitted these may be an under-estimate.

She said progress to clear the pandemic's backlog had been slower than she would like, but insisted "we are getting there".

The waiting list for treatment in Wales currently stands at just over 743,300 - some 582,000 individual patients - with the Welsh government's goals to reduce the waits still not met.

"I think we need to change what we do," she said. "One of the things that we really need to focus on is how we focus on keeping people well: preventing ill health; supporting our patients to make good choices around what they do."

She pointed to "the huge challenges ahead of us" posed by obesity and diabetes and the need for people to keep themselves well.

The way services are delivered has been changing though, she said.

Speaking at the Bevan Commission Conference in Newport on Wednesday, First Minister Mark Drakeford said people needed to take better care of themselves and the health service should not waste its "precious" resources.

He also defended the NHS against those who "plan" and "plot" against it and focus on its failures instead of its successes.

"Too many people have come to take it for granted," said Mr Drakeford.

"We've forgotten the need to fight for the NHS. You know what Aneurin Bevan said, of course, 'the NHS will survive for as long as people are prepared to fight for its future'."

Ten years ago controversial plans to centralise some specialist services in south Wales were scrapped.

A different model is evolving, but with the development of a regional diagnostic hub and centres specialising in orthopaedics and eye surgery all serving patients from several health boards, waiting times have reframed the discussion.

Ms Paget said: "I think it's really important to have those conversations with the communities that might be affected by any change, but certainly what we need to do is focus our resources on delivering the best health outcomes for patients.

"What we see at the moment is technology and research pulling us in two directions.

"There is much more that we can do outside hospital in people's homes; in local community settings; in local doctors' surgeries, GP surgeries; in other primary care establishments.

"So we've got something that's pulling us this way - to decentralise. And then obviously we have got another pull, which is about the need to centralise our very specialist services more.

"We need to provide opportunities for people to access diagnostics really quickly and the most efficient and effective way of doing that is in larger centres where we centralise things together."

Given the low staff morale and patient frustration over access to care, is the 75th anniversary of the NHS a moment to celebrate, or take stock?

"I think we should be celebrating the staff of the NHS," she said.

"They've gone through a huge amount over the last few years. They are continuing to be very challenged.

"I think the constant criticism that they feel actually affects their morale as well.

"So I think it's a time to yes, take stock and reflect. But, actually, I think there is a stronger need to celebrate what the staff are doing in the NHS every day to support us."