Confed Viewpoint blogs

Health and care face operational and financial pressures like never before

Director of the Welsh NHS Confederation Darren Hughes reflects on the challenges of the last couple of months and those ahead of us.
Darren Hughes

1 February 2023

The last two months have been like no other for the health and care system, with demand on some parts of the system the highest on record.

It has been widely reported that December and January were the toughest months ever for the NHS, particularly over the Christmas period and the weeks that followed. Operational data shows that the 27th of December 2022 was the busiest day on record with over eight per cent of total bed capacity taken up by those in hospital with Covid or flu (and in some cases, both), and 12 per cent of capacity taken up by delayed discharges, before even considering urgent and emergency care demand. Thank you to all staff for their commitment and hard work during this time.

Unprecedented pressures are a result of record demand in both primary and secondary care, a difficult respiratory virus season, staff absences and vacancies, exacerbated by ongoing industrial action. NHS leaders tell us patients are presenting with increased levels of serious illness, and the true long-term impact of the cost-of-living crisis is not yet known.

December saw the highest number of red (immediately life-threatening) calls to the ambulance service ever made in a month and the highest average daily number of red calls, up 25 per cent from November (which itself was the highest recorded up to that point). Compounding this were a total of 31,319 hours lost to handover delays, with more than 291,345 over the course of 2022.

Our colleagues in primary care are seeing around 400,000 people every month and Primary Care Centres and Same Day Emergency Care services are supporting 7,000 people a month to access urgent care away from emergency departments. Creating extra community capacity and improving patient flow has also been a huge focus for health and care leaders this winter – one that remains a priority.

Thanks to the hard work of health and care staff and the nature of the waves of winter viruses, the position has improved since record Christmas pressures - but this does not mean we are out of the woods.

Industrial action couldn’t have come at a more difficult time for the NHS. NHS leaders know that the decision to strike is not one staff will have taken lightly and understand staff who say they no longer feel able to provide the level of care their patients need and deserve because of system pressures. The NHS has coped – to a point – on strike days so far, thanks to enormous efforts across teams to minimise disruption for patients. But there’s a cumulative effect, and the longer strike action goes on for, the more disruption we’ll see for both patients and staff. All the while this continues, the NHS won’t be able to break out of the vicious cycle it’s stuck in, which is why we need governments and trade unions to leave no stone unturned to work towards a resolution.

As outlined in our response to the Welsh Government’s Draft Budget 2023-24 and during our evidence session to the Senedd’s Finance Committee, NHS leaders acknowledge the current budgetary limitations facing the UK and Welsh Governments and welcome the uplift to social care workers’ pay. But the NHS is currently facing its greatest ever financial challenge: inflation, the elective care backlog, rising energy costs and the ongoing costs of Covid have led to exceptional cost pressures, resulting in the NHS in Wales facing its largest financial deficit. Current financial allocations to the NHS and wider public sector mean that we are all going to have to think the unthinkable. Setting out the scale of the challenges NHS organisations are facing and working towards solutions is going to be a key focus of our work for the foreseeable future,

As highlighted in our recent Wellbeing for Wales webinar, all sectors must work together to tackle inequalities and the cost-of-living crisis to prevent further harm to the most vulnerable in our society. If we’re going to meet the needs of the population, we need a long-term investment plan and clear priorities for the health and care sector. This must include investment in NHS buildings and infrastructure and delivery of the long-awaited strategic workforce plan.  

Without longer-term financial clarity, there’s only so far the NHS can go in training, recruiting and developing a workforce that can meet future demand and deliver service transformation – our current situation is severely limited by past under-investment across the whole of the UK. 

While acknowledging the restrictions governments face, it’s vital that they’re open about the pressures facing the NHS and social care and what the public can expect in the future. We will need political support to radically re-think how services are delivered in the longer term. It’s positive to see Welsh Government revisiting the One Wales Public Service concept, as the huge challenges society is facing cannot be overcome by the NHS alone.