By Dave Reid
We cannot go on like this. That is the substance of the letter from A&E consultants to the Welsh government.
A&E consultants in Wales have written to First Minister, Carwyn Jones, to draw attention to the huge crisis in Welsh hospitals this winter. This letter follows on from a similar letter that A&E consultants in England have written to Theresa May.
The consultants say that patient safety is currently being compromised to such an extent that patients are dying. They clearly identify the cause of the problem: “We have neither sufficient staff nor sufficient beds (in either acute hospitals or the community) to cope with the needs of an ageing population.”
“We’re on our knees as far as emergency care [is concerned]. There’s good evidence that if patients are seen in emergency departments which are crowded, that are full, their treatment is delayed. That can actually cause an increase in the length of stay, it can make their illness more severe and in some cases it can cause death, so for safety and patient care we’re very, very worried.”
A Tale of Two Governments
While the NHS in England is run by the Tories, the NHS in Wales is run by Welsh Labour. The two things that the health service in the two countries have in common is that there are huge crises in hospital provision this winter and they are both chronically under-resourced.
The Welsh government’s response to critics is essentially the same as the Tory Westminster government’s response – they laughably claim they prepared for the extra demands imposed by the winter health crisis and they have apologised to patients for cancelled operations.
The Welsh ministers should also apologise to NHS staff who have worked way beyond their contracted hours to try and keep up with the increase in demands on the NHS and have been rewarded with years of real pay cuts and cuts in pensions. The NHS is being kept going by the goodwill of underpaid NHS workers in the face of huge cuts. The consultants report countless examples of staff in tears because they feel they cannot deliver the care patients need.
There have been terrible stories of seriously ill patients waiting for over a day to be admitted to a hospital bed. The Welsh A&E consultants tell stories of staff arriving for work to find patients in the emergency department who were there the previous day.
Underfunding, not flu, the cause of the crisis
The Tory UK government is mainly responsible for the underfunding of the Welsh NHS but Welsh Labour bears some responsibility too. They have implemented the Tory spending cuts with scarcely a whimper of protest, cutting the Welsh NHS spending even deeper than the Tories in England until 2014.
A socialist government would not ‘go gently into that good night’ and meekly accept the cuts. It would set a budget that matched the health needs of working people in Wales and fight the Tories in Westminster with every weapon at its disposal to fund it. Instead the Welsh Labour government has concurred with the cuts and re-organised the Welsh NHS to match the limits demanded by a capitalist elite who insist that public services must be curtailed to pay for the economic crisis.
Welsh Labour’s approach is closer to Tony Blair’s than Jeremy Corbyn’s. They have defied mass protests and demonstrations, many called by Socialist Party Wales, and closed A&E departments across Wales. The South Wales Programme is reducing A&E provision down to just five for the whole population of South Wales. Many emergency patients in mid-Wales have to travel long distances to English hospitals because there are no A&E departments in the region. In North Wales there are just three A&E departments.
Primary care promises broken
Every cut in hospital provision has been accompanied by the promise that a new model of care is being implemented that will boost primary care and provide care closer to patient’s homes – in health centres, GP surgeries and at home – to reduce the need to go to hospital. Socialist Party Wales has accepted that that might well be a laudable aim, but the primary care provision should be put in place first and then hospital provision reduced as demand for hospital care is reduced – if it is reduced.
In fact very little has been done to provide extra resources in primary care while hospital provision has been slashed. The result is that thousands of patients, many of them elderly, have swamped the reduced hospital facilities and the winter flu epidemic has become a serious health crisis. As the consultants have warned people might die as a result of the failure of the NHS to cope with the demands.
A damning report last week headed by the chief medical officer that called for a “revolution” to provide adequate social care shows that having got away with closing the A&E departments very little has been done to provide the primary care that was promised to reduce the dependency on hospital services. The net effect of Welsh Labour’s changes is of increased demand on reduced hospital services. Result: a winter beds crisis.
Action needed to avert a catastrophe
In fact the Welsh NHS is in permanent crisis. The problem is most acute at this time of year but there are appalling stories of patients being let down by the under-funded NHS all year round. The BBC reported the story of 81 year old Edward Steward who lay in pain on a hospital trolley for three days at UHW Hospital in Cardiff in October.
One of the arguments of Welsh Labour and the Tories has been that the NHS is having to deal with an ageing population. And in Wales health needs are especially acute because of the higher average poverty levels. But both these factors mean that there must be a plan developed to put in place new beds, A&E departments, geriatric facilities and doctors and other staff to deal with the expected increase in demand. As long as the current level of provision is maintained – let alone cut further – then the situation will actually get worse in future years. We cannot go on in the way we are now.
There is a special crisis in the ambulance service. Vaughan Gething, the Welsh health minister, has boasted that the ambulance service has improved achieving its targets in reaching ‘red’ calls within eight minutes. But that is only because the targets have changed.
The ambulance targets have been changed to prioritise life-threatening emergencies. Of course life-threatening emergencies should be prioritised, but not at the expense of other seriously ill patients, especially as its the public who is expected to diagnose patients at the scene of the accident.
Unless the patient is unconscious, has stopped breathing or is bleeding to death then they are left to wait – sometimes for many hours. Some dying patients suffering from internal bleeding have waited for hours for an ambulance. Stories abound of injured people lying on the pavement for five hours or more. One victim of a road traffic accident in Swansea was kept waiting for three hours in her car for an ambulance to arrive and remove her from her vehicle to take her to hospital.
None of this is the responsibility of the paramedics who are also working under enormous strain and are as frustrated as the doctors.
Both the Welsh and UK governments put the blame for the ambulance crisis on the log jam at the hospitals, ambulances are queued outside A&E departments waiting for their patients to be assessed and admitted. But in addition to the hospital crisis the ambulance service simply does not have enough ambulances and paramedics to provide an adequate service. Even when there is not a winter beds crisis patients often have long waits for an ambulance to arrive.
There is only one solution to the ambulance crisis – more ambulances and paramedics.
A plan must be put in place now to deal with an ageing population with an expanded NHS, not the managed decline Welsh Labour is promising.
Socialist Party Wales demands:
- End the NHS crisis – reverse the cuts.
- Re-open closed A&E departments.
- Increase the number of ambulances and paramedics to provide an adequate ambulance service.
- Implement an emergency medical student training programme to train new doctors and nurses
- Provide free medical education for medical students who stay to work in Wales.
- Return the student nurse bursary scheme.
- End the 1% pay cap! National co-ordinated industrial action to win 5%.
- Fight for sufficient funding to provide decent healthcare and prepare for an ageing population
- The Welsh government sets a needs budget and campaign to force this weak Tory government to increase funding.
- Support the February 3rd demo for the NHS in London called by Health Campaigns Together.