Eluned Morgan MS, Minister for Health and Social Services
The increased emergency pressures on the NHS, which have been so evident over the winter months, have been compounded by a number of factors, including concurrent surges in a range of respiratory viruses, including Covid-19, flu and scarlet fever.
But external factors, such as the ongoing consequences of Brexit, the cost-of-living crisis and the war in Ukraine, are all also impacting our health and care services.
I have recently spoken about the need for clear priorities – this statement highlights the priorities I have set for the health service in Wales. They will help address the immediate pressures and help to build a sustainable health and care service over the next year.
It is important people play their part in helping the NHS by looking after their own health and wellbeing and taking steps to stay well. I want to continue this conversation with the public so together we can create a healthier population, reduce pressure on acute NHS services and improve outcomes in the longer term.
The current environment means the priorities need to be targeted to the challenges we face. The NHS Planning Framework 2023-26 sets out the broad requirements that will underpin NHS plans going forward – this includes the importance of quality, safety, prevention and good health outcomes at the heart of the NHS in Wales.
We must continue to focus on population health and prevention as the route to better health and wellbeing and to sustainability in the longer term. Reducing inequity and improving the quality, safety and experience of those in need of health services must always be a driving force in service planning and delivery. Delivering efficiently, effectively, and optimising service delivery is how the improvements must be embedded in the DNA of the NHS in Wales.
It is crucial the NHS focuses on these priorities so resources and capacity can be used to make a real difference to people throughout Wales.
Members will be very well aware that frailty is driving demand for healthcare, particularly urgent emergency care, and social care. Once clinical interventions are complete, people should be able to return to the community, and services must be available in an integrated way to facilitate that. That's why in this calendar year I am prioritising work to increase the number of healthy days at home for people experiencing frailty.
This must be an equal partnership between the NHS and social care organisations, and be really focussed on people receiving a consistent standard of community care across Wales. The approach, backed up by improved data collection will provide a better basis for focused support. In developing a plan for this work with organisations and other key partners, the aim is to have regions and localities working towards the national service specification and workforce model well ahead of next Winter, and for there to be means in place for identifying relative impact.
- A closer relationship between the NHS and local government to tackle delayed transfers of care, and an effort to move further and to deliver an integrated community care service for Wales is essential. Work is ongoing across health and social care to introduce the Pathways of Care Reporting framework for delayed transfers of care in 2023. Health boards will be expected to use this to monitor the progress of safe and timely discharges of patients. All organisations must deliver care closer to home. The focus should be on doing the right things to support people, to ensure they receive the care they need at home.
- Improving access to general practice, dentistry, optometry and pharmacy This will include independent prescribing and increasing self-referral to a wider range of community-based allied health professionals, including rehabilitation, mental health and audiology.
- Urgent and emergency care must focus on the effective management of people with urgent care needs in the community 24/7, and help more people to safely access alternatives to hospital-based care, for example through robust, seven-day same-day emergency care services and integrated health and social care community response models. Health boards must work with partners to significantly reduce the time patients spend waiting in ambulances outside emergency departments.
- Planned care and recovery is being led by the National Recovery Programme, which will set specific requirements for health boards. Meeting these requirements must be a priority. Regional diagnostic centres and treatment centres should be at the forefront of organisations’ plans. This must include actions to move services, workforce and funding from hospitals into the community so people need to go to hospital when it is right for them. Organisations must demonstrate how they will deliver a significant increase in the numbers of patients who undertake pre-habilitation. Diagnostics services improvements must result in a reduction in numbers of people waiting for diagnostic tests to pre-pandemic levels as a minimum, including for mental health diagnosis.
- Cancer services must enact the quality statement on cancer and ensure there is a reduction in the backlog of patients waiting too long on the cancer pathway. Achieving the required standards must be a priority for health boards.
- Mental health and child and adolescent mental health services there must be improvements across all age services and equity and parity between physical and mental health services. Health boards must plan to expand tier 0/1 support to provide easy access to population level support for lower-level mental health issues, improve services across CAMHS, adults and older adult services and implement 111 press 2 for urgent mental health support. Reconfiguring eating disorder services to target earlier intervention and ensure a maximum of a four-week wait for routine access to eating disorder services is required. Improving memory assessment services to obtain a timely diagnosis and treatment should also be included. Improved access to full range of all age mental health and wellbeing services, particularly for children and young people, boosting prevention support for adults and children and de-medicalise the approach to mental health services where appropriate.
Core Supporting Functions
Digital, innovation, technology and transformation must underpin the delivery of optimum care and services for patients, alongside workforce, wellbeing and robust financial management.
It is important the NHS focuses on ways to deploy the existing and future workforce to best effect. This includes enhanced use of multidisciplinary teamworking, role redesign, developing new roles, and advanced practice models, enabling people to develop their careers and work at the top of their license.
The economic and financial outlook is extremely challenging. The value of the overall Welsh Government budget has fallen in real terms by £3bn over the current spending review period. A renewed focus on cost reduction and value improvement in the NHS is therefore critical to ensure the ongoing sustainability of services.
Robust financial planning, fully integrated with service and workforce planning, is essential, as is tight financial governance and financial management. Capital plans must be prioritised and aligned to decarbonisation targets.
The role of NHS organisations as anchor institutions provides a driver to implement care and services in a way that supports individuals and communities as part of normal business. This will include the approach to the foundational economy and how the NHS can respond to the cost-of-living crisis for both patients and staff.
The net zero target for the public sector in 2030, decarbonisation action plans and social value, as part of contributing to achieving the aims of the Well-being of Future Generations (Wales) Act 2015, remain as commitments and opportunities to build in actions and benefits as part of service planning and should be taken.
All NHS organisations must submit board-approved plans providing firm commitments about how these priorities will be delivered by 31 March 2023.
This is a challenging period in which to plan and deliver health services but I am confident the NHS will continue build on the progress and learning from the pandemic and the ongoing pressures to deliver the sustainable services we all want.