The Welsh NHS needs a "renewed focus on quality" if it is to provide an acceptable standard of healthcare to patients across the country. That's the warning from Alun Jones, chief executive of independent regular Healthcare Inspectorate Wales (HIW), who has outlined the biggest problems facing the health service to coincide with the organisation's annual report.
Throughout the last financial year, HIW carried out nearly 200 inspections of healthcare settings in both the NHS and the private sector. It identified sustained pressure on emergency care, as well as concerns around staffing levels, risks around managing patient safety and the accessibility of face-to-face appointments.
HIW also received 514 concerns from members of the public and healthcare staff between April 2021 and March 2022 - a 40% increase since the start of the coronavirus pandemic in 2019-20. It also received 61 whistleblowing concerns - 17 of which were deemed "high risk" and needed escalating to health boards and independent healthcare providers.
Read more: More than 50 NHS Wales leaders say social care is in a 'state of emergency'
Some of their most damning inspection reports over the last 12 months have included the accident and emergency department at Ysbyty Glan Clwyd in Denbighshire where a "clear and significant risk to patient safety" was identified last May - you can read more about that here - and a review of handover delays between the Welsh Ambulance Service and hospital A&E departments which can be found here.
While inspectors concluded that healthcare was of "a good standard" overall in Wales, it identified that services were under intense pressure from the impact of the Covid-19 pandemic, with many workers facing burnout and low morale.
"We know that some staff are leaving the service; maybe they're close to retirement, maybe they've had a very difficult period over the last couple of years that has led them to make decisions about their future employment," said Mr Jones. "Staffing numbers can be an issue that not only puts a strain on the service, but also on the staff left behind. They can be under a lot of pressure and they're doing their very best to meet the needs of the public.
"This is particularly true in mental health services where there are very vulnerable patients. They can often be suicidal or self harm. If you don't manage to achieve safe staffing levels, then the impact of that can be horrific."
Mr Jones said unscheduled care, such as A&E departments, required more improvement than scheduled care, such as oncology and cardiac wards, as they had less control over admission and patient flow. This problem has been further exacerbated, he claims, by people struggling to access their GPs and other primary care specialists in a timely fashion. "We're introducing risk to the patients because they can't see everybody quickly enough. It also becomes more difficult for staff to receive training to keep up-to-date with their skills," he added.
One of the biggest issues affecting the flow of the entire health and care system, Mr Jones said, is delays in getting patients discharged from hospitals when they're fit and ready to do so. It is understood that up to 1,500 people are medically fit but cannot leave hospital because of a lack of social care.
"Getting packages of care set up around the patient has become very difficult. We all know that there's a big debate going on about what carers get paid - and we know there's a workforce shortfall there as well," he said. "Ultimately the consequence of that is beds being taken up by people who are not best-placed to be in hospital. That is taking up capacity in hospitals which has an impact on the front door in emergency departments."
Now that coronavirus has become far less of an issue for hospital staff, with just a handful of patients currently receiving active treatment for the virus, Mr Jones believes the time has come to get clinicians out of "emergency pandemic mode". He explained: "The healthcare system went through this enormous challenge over a two-year period where perhaps, at times, I would accept that they had to compromise on certain things because there were, for example, dealing with 1,000 patients with Covid.
"But as the system begins to recover and [normal] services start going again, I think one of the most important things that our work has done is remind people of the standards that need to be met. Sometimes a culture has perhaps set in where staff are still in that emergency pandemic mode and have lost sight [of what is expected]."
HIW has also had to carry out a lot of its work remotely or virtually, particularly when the Covid infection rate was at its highest in parts of Wales. But Mr Jones said that it worked to their advantage and allowed staff to be more open about any issues they'd experienced.
When asked whether the NHS was sustainable and safe in its current guise, he concluded: "It is safe in general. There are lots of challenges to maintaining quality when a service is under pressure. We have to acknowledge that and what we'd ask of the NHS is that there's a renewed focus on quality coming out of the pandemic. I know that there are lots of people working very hard on solutions to to capacity demand and being innovative as well."
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