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Challenges facing the NHS in Wales highlighted in new report

A need for more collaboration between clinical and managerial leaders in the NHS in Wales has been identified by ‘The State of Surgery in Wales’ report, published by the Royal College of Surgeons.


With no medical staff representation on board or executive roles in health boards in Wales, except the Medical Director. The report says there is a clear need to elevate the professional and clinical agenda within the decision-making process in health boards and calls for political parties to set out how they will achieve this in advance of the Assembly elections.



Alongside this, lay representation should be included at all levels of the NHS, especially at Local Health Boards.


The State of Surgery in Wales report reviews the key challenges facing surgery in Wales, including the finding that many surgical patients are waiting too long for treatment. The Welsh Government’s target is for at least 95 % of patients to have waited less than 26 weeks from referral to treatment, with 100% treated within 36 weeks. The data shows that neither of these targets is being met. Reducing waiting times should therefore be a top priority.


The report also found that clinically necessary service changes have progressed too slowly, often impeded by politicians campaigning against change. It recommends that health boards should be required to collaborate on their planning and provision of services and that political leaders need to spend as much time engaging with the clinical case for change as listening to public concerns. Emergency surgery is just one example of where service change is desperately needed to improve patient care.


Critical care bed capacity needs to increase and action must be taken to tackle any inefficient use of existing critical care beds. Data showing the number of available and occupied critical care beds should be published on a monthly basis.


The publication of surgical unit outcomes data should be prioritised to drive forward improvements in care. Data on cancelled operations, with reasons for that cancellation, should also be published monthly.


Working with royal colleges in Wales, the Welsh Government should review the existing provision of services at night and at weekends, with a view to drafting a strategy to improve 24/7 support for urgent and emergency patients.


There needs to be a much clearer system of inspection and external challenge which should continue to include specialist clinical leads in inspection teams, and should incorporate third party intelligence and data. Consideration should also be given to appointing a Hospital’s Inspectorate within HIW to support the wider work of HIW.


The Welsh Government should look to commission a review to look at what more the NHS can do to support the uptake of innovation and new techniques.


The report also highlights the need for better data and transparency to more accurately assess the quality of care provided.