Is the Welsh NHS being brought to its knees by Labour and budget cuts?
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Version 0 of 1. “The care I’m getting here is great. It couldn’t be any better. I come in and I’m made to feel comfortable right away. The staff are great and the atmosphere in the hospital is good”, says Stephen Murphy, a patient at the Velindre Cancer Centre in Cardiff. The 53-year-old electrician, who has stage 4 skin cancer, as well as secondary lung cancer, finds the 45 minutes of reflexology he receives during his visits “very calming and very helpful with my energy levels, which have been spinning around all over the place”. And he appreciates the “definite camaraderie” between patients undergoing chemotherapy, radiotherapy or palliative care at the Velindre. As well as providing high-quality medical care, staff also prioritise patients’ psychological health, given the anxiety a diagnosis of cancer triggers, says Andrea Hague, director of the 50-bed, £50m-a-year hospital. Its helpline, staffed 24/7 every day of the year, lets patients ring in for advice about symptoms, information about their treatment or just for a chat, any time they want. “We are the best cancer centre in Wales – as rated by Macmillan Cancer Support – and one of the best in the UK”, says Hague. The health service in Wales is coping remarkably well despite being under huge pressure While the Velindre is acknowledged as offering an excellent service, the quality and performance of the NHS in Wales has become one of the most bitterly disputed issues in British politics. For many months, every time Ed Miliband has accused David Cameron of overseeing a mounting crisis in England’s health service, the prime minister has sought to embarrass the Labour leader with a series of claims about the Welsh NHS. As well as highlighting that key NHS waiting time targets have been missed by wider margins in Wales than in England, Cameron has also sought to make political capital out of the fact that the country is the one part of the UK to have cut its health budget since 2010. He has even gone as far as to claim that Offa’s Dyke has become a “line between life and death” as a result and that patients have been “dying on waiting lists” because of Welsh Labour ministers’ decisions. Mark Drakeford, Wales’s minister for health and social services, has responded by decrying the Conservative campaign as a “tissue of lies” and a “ploy” to drag the Welsh NHS’s reputation through the mud “for entirely partisan political purposes”. In his office beside the Welsh National Assembly, Drakeford’s mood swings between calm reassurance, exasperated rejection of some of the claims and visible annoyance. Related: The Guardian view on the Welsh NHS: all in it together | Editorial The NHS is coping “remarkably well” despite being under huge pressure, he says. “There were 19m GP appointments last year, plus 7m other patients who saw a practice nurse, as well as 1m attendances at A&E, 750,000 operations, and 3m outpatient appointments – all for a population of three million people. “Demand for NHS services is already significant and will go up because of our ageing population – we are the only country of the UK that is a net importer of older people, due to people retiring here – and our industrial heritage means that we have reservoirs of ill-health, especially in south Wales, and high levels of chronic conditions”, says Drakeford. The Westminster coalition’s austerity programme, which Wales’s Labour government says has seen its overall budget fall by 8% in real terms since 2010, has made the difficult task of running the NHS even harder. The Barnett Formula’s intrinsic unfairness to Wales means it is missing out on £300m a year that it deserves and needs, he adds. Drakeford, a professor of social policy and applied social sciences at Cardiff University since 2003, points out several areas in which Welsh NHS performance exceeds England’s. “In the winter just finished we had some difficult days, especially in January, but no Welsh hospital declared a major incident. At the same time, hospitals along our border did that and were no longer able to take patients. That didn’t happen in the Welsh NHS once, where we have a planned system of mutual aid, under which our hospitals aren’t in competition with each other, in contrast to a marketised system [in England]. We are also fortunate in Wales that our social services departments are part of the mutual aid system.” On social care, Drakeford is scathing about coalition’s austerity-driven cuts to local councils’ budgets in England leading to cuts in at-home services that have left its NHS having to deal with even more patients. There were 19m GP appointments last year, as well as 1m attendances at A&E, and 3m outpatient appointments “We’ve not robbed our social services departments to make it look like we have artificially inflated our health service budget”, he says, in a direct swipe at the Conservatives’ proud boast that they have successfully increased the NHS budget in England every year since 2010. He points to the fact that delayed transfers of care, often referred to as “bedblocking”, have reached an all-time high in England recently, increasing congestion in hospitals, but stayed flat in Wales. That is due to collaboration between health and social care, says Drakeford. The Conservatives have consistently baited Miliband with the indisputable fact that, unique among the four home nations, Wales has cut its health budget in real terms since 2010. “That’s simply a distortion of the truth”, says Drakeford. The reality, he insists, is that the Welsh government has protected health and social services spending because they see them as one joint, and vital, single package of services, given so many people – especially the elderly – rely on both. “Our critics are distorting the strategy that we’ve had, which is to fund the system in the round. It’s no use to an older person to find themselves admitted to a hospital that appears to have had its budget protected, only for them to find that they can’t return to their home because social services are no longer there to support them.” Welsh government figures show that since 2010, health and social care together have been receiving a growing share of a budget that has been reducing. In 2010-11, they accounted for 41.3% of Wales’s total budget. It was 42.5% in 2014-15 and will rise again, to 43.4%, or £6.7bn of the government’s £15bn total spend, in the year just starting. However, Drakeford admits that the Welsh system’s performance on key waiting times – in A&E and for planned treatment in hospitals after referral by a GP and for ambulances to respond to 999 calls – has not been good enough. Those are “areas of challenge”, he says. But he also contrasts the policy in some English hospitals of admitting patients just before four hours is up, to try and meet the 95% target, with the approach in Wales of worrying less about that target if the patient is still waiting for an X-ray to come back or undergoing “watchful waiting” to see if they improve. Dr Paul Myres, chair of the Royal College of GPs in Wales, says that, despite missed waiting time targets, “the NHS in Wales gets a very unfair press. Conservative politicians are saying that it’s not as good as the NHS in England. But, broadly, that’s false, because people who really need to be seen urgently are seen, for example for cancer.” Professor Mansel Aylward, the chair of Public Health Wales and a professor at Cardiff University’s medical school, knows more than most about Wales’s NHS, having chaired the Bevan Commission – a standing panel of experts – since 2008. “It’s unfortunate that some of the statements made have been inaccurate and verging on abuse of the Welsh people. You can’t say that the health service is better in England. I could mention the Francis Report into Mid Staffs, but you can’t conclude that an entire country’s health system is rotten because of that. If you compare Wales with north-east England, or Liverpool or Inverclyde in Scotland, or any other post-industrial area, there’s not that much difference between health outcomes and the quality of care that’s delivered.” How Wales compares A study published in April 2014 by the Nuffield Trust, The four health systems of the UK: How do they compare?, examined the performance of the NHS in each of the four home nations since devolution in 1999 gave the Celtic countries control over their health services. The thinktank updated its analysis in January 2015 as a result of the claims being made, by the Conservatives and the Daily Mail, about the state of Wales’s NHS. Last year’s report found that all four nations made major improvements in their NHS during the 2000s, and no one country was consistently ahead or lagging behind the others. However, while health spending slowed since 2010 in all countries, Wales was the only place to reduce its health budget in real terms. Health spending in Wales fell by 4.3% between 2009/10 and 2012/13. But ministers agreed to put in more money during 2014-15 and 2015-16 in order to reverse this trend. The trust also found “worrying signs of lengthening waiting times for common procedures in Wales. For example, a Welsh patient waited 100 days longer on average for a hip operation than an English or Scottish patient in 2012-13.” Its updated analysis in January, which looked specifically at performance in Wales compared to England, concluded that “Welsh patients have real grounds for concern on waiting times. Ambulance response times, time spent at A&E and waits for planned treatment are much higher in Wales. For example, in January just 49% of Welsh ambulances responded to life-threatening calls within eight minutes, compared to 68% in England.” However, more positively for Wales, more cancer patients get treatment within 62 days there (88%) than in England (83.6%). In addition, hospitals in Wales have not experienced the same rise in either delayed transfers of care, known as “bedblocking” or emergency admissions that have been seen and caused such problems in those in England in recent years. For instance, although delayed discharges have gone up by about a third in England since 2010, in Wales they have stayed broadly flat. “Looking purely at some of the totemic targets, such as time at A&E and ambulance response times, it is irrefutable that Welsh patients are waiting longer than English patients for care”, says Nigel Edwards, the Nuffield Trust’s chief executive. “This may be partly because the Welsh government has made different spending decisions and has placed greater emphasis on prevention, public health and social care. It has also adopted a less ferocious approach to managing the system’s performance than in England.” |