Peaks, troughs and stark warnings


If you had any doubt about the priorities facing the Welsh government during the next Assembly term and beyond, then the Director of the Royal College of Nursing in Wales has spelt them out pretty starkly.

You will put "creating economic growth" right at the top and few would disagree. But Tina Donnelly is clear that there is another urgent priority in the health minister's in-tray, a problem that unless it's tackled, will engulf Lesley Griffiths.

Clinicians offering acute services are used to busy winters. More people get ill, flu epidemics flare up, Accident and Emergency departments are full to bursting. The problem this year is that the added pressure didn't ease off as the sun came out and the jumpers came off. The demand has been "unprecedented" throughout the summer say the RCN. Forget peaks and troughs - think peaks, constant peaks, unsustainable peaks that drain both the staff and the budget.


Let's be clear: Tina Donnelly doesn't put this surge in demand down to daft 999 calls. This isn't about hamster bites and drunken calls for an ambulance because it's cheaper than a taxi. This is about the closure of minor injury units, she argues, when there aren't enough clinicians to provide cover. This is about not enough of the much-vaunted alternative care in the community, about people not trusting that care, about people turning up in A+E and acute care hospitals because they know they'll get quality care. They know the staff on the front line - and the Local Health Board - will treat them and won't turn them away.

Tina Donnelly is blunt: "The difficulty is you cannot help being ill in Wales so the demand is there ... Let's be clear, when the Assembly returns we have to make it really a priority in Wales to say we've got unprecendented utilisation of acute care services, we have inadequate provision in the community. That has to be fixed otherwise I don't know how health boards are going to manage, I really don't".

Those health boards are already overspending. They've been told there's no more money to bail them out. They've been told by the Health Minister that this time, she means it.

She may well mean it but Tina Donnelly means it too when she says the demand for acute care is sky high, that it cannot be sustained on current budgets and that it "has to be fixed."

Betsan Powys Article written by Betsan Powys Betsan Powys Former political editor, Wales

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  • rate this

    Comment number 59.

    #58, succinct evaluation of a bore ...

    #57, your earlier comment relating to rural provision, do you believe that if there were more cottage hospital / triage provision with rapid response and transfer to larger hospitals for the seriously ill, the public would respond positively ?

    There seems to be a kernel of a solution in there ...

  • rate this

    Comment number 58.

    So we are all right wing because we don't agree with Mabionglyndwr's views. That is indeed funny, from a person who belittles anyone who doesn't agree with him , rants and raves , shout down anyone , abusive, rude, insulting ,intimidates, and humiliates towards anyone who dare disagree, and we're right wind?? I find you very much describing yourself when you say others have extreme views.

  • rate this

    Comment number 57.

    "Labour pre & Welsh Lab post Devolution have been in power in it's decline/mismanagement" - Agree

    " the Tories never wanted an NHS" - Disagree

    We have no idea,probably will never know, how Plaid would run the NHS

    As for devolution, problem is, its not run by Welsh people for Wales, its run by activists building a pseudo cultural reserve.

  • Comment number 56.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 55.

    53: I'm firmly in reality but you drift in and out of it pal! You must be a insane if you think Plaid would ruin our beloved NHS but would nuture it. Remember the Tories never wanted an NHS & Labour pre & Welsh Lab post Devolution have been in power in it's decline/mismanagement and you have the bloody cheek to attack Plaid whilst the NHS has been largely under they're watch since 1948. Clueless!

  • rate this

    Comment number 54.

    Re 53

    So, are you now calling Alf nauseous, John?

  • rate this

    Comment number 53.

    ... NHS 1948, perfect.

    ... NHS 1955, cured TB, perfect.

    ... NHS 1965, cured meningitis, perfect.

    ... NHS 2012, knee repairs, perfect.

    All in Wales, without the nauseous nationalists at the helm.

    Now what is needed are visionaries for the future ... with a grasp on reality.

  • rate this

    Comment number 52.

    The NHS was perfect before Devolution wasn't it Brit Nats? Underinvestment by London now means it's impossible to find NHS Dentist thanks to the Tories who encouraged Dentists to go private, No Children’s hospital in Wales ( 16 in England) until it was created by charity donations+Assembly funds showing Devolution working! The far right will always twist agendas to encourage hate. Pathetic!

  • rate this

    Comment number 51.

    Again the far right Brit Nats out there are blaming everything but the weather on Devolution but the problems in the NHS are not solely fault of the WG alone IE: lack of investment by past London Governments in training home grown Docs & Nurses now detrimental to Wales, an aging population, Illness due to industry, Lifestyles, Credit crunch. Hey, It's currently sunny thanks to London, Clowns!

  • rate this

    Comment number 50.

    Abolishing Devolution to serve your narrow self interest doesn't improve anything, you think extra money will be spent in Wales when its proven that we are underfunded by the Barnett formula and the UK government refuse to address that issue?

  • rate this

    Comment number 49.

    Following the English example is not a good idea, the system there is about to face massive reorganisation and privatisation, neither of which are happening in Scotland or Northern Ireland (we have never had a UK wide health service). The English NHS is crippled with debt from PFI and faces serious problems. It simply isn't true that on every measure the English NHS out performs the Welsh NHS.

  • rate this

    Comment number 48.

    45 The solution of some is to ignore the failure of devolution - and to persue their narrow nationalist agenda by changing the voting system. Using the recent referundum as a clue then the Welsh and the rest of the UK are happy with FPP.

    The problems with the NHS in Wales are the result of failures of the WAG and devolution. In the last 14 year which party has held an overall majority?

  • rate this

    Comment number 47.

    We do have some challenges in Wales, a dispersed population and where there is a population concentration its in valleys with little communication between them - poor roads and little public transport. Also a sicker and older population. These are distinct issues that need to be considered in any planning of a health service. Also if health had been saved cuts what else would have had to go?

  • rate this

    Comment number 46.

    44 When something is broken you either fix it or bin it. Changing the governing party to suit your narrow agenda is not acceptable to the majority of us in Wales.

    Also you miss the point. The NHS in England outperforms our NHS on every measure depite the depression (sic).

  • rate this

    Comment number 45.

    List AMs are voted in as a result of the public vote, the public have as much control over who is elected on the list as they do for constituency members. Ultimately the solution though is to go to STV where every vote counts and where the electorate have the greatest control over who is elected.

  • rate this

    Comment number 44.

    Amazing isn't it - the solution of some is always to abolish devolution, not change the party governing. Lets see, the economy is in the hands of the UK government entirely, the UK is in a depression so the solution must be to abolish Westminster!

  • rate this

    Comment number 43.

    #41 Decentjohn
    you are right Devolution is not working - part of the problem is the structure of the Assembly, but also the presence of the List AM's, which together with lack of public support leads to a poor quality of AM's across all parties

    Voter turnout at the referendum and Assembly elections is appalling, This is not Democracy - it is a construct of a few academics, activists and the BBC

  • rate this

    Comment number 42.

    John #39
    There are innovative solutions - but we have major problems overcoming Health Board and other Administrative structures and lack of vision.

    An instance; my grandson had to visit the Heath for a series of appointments Each was a day off work and a round trip of 6 hours.- last visit saw the consultant for just a few minutes, no examination just told tests results not complete more needed!

  • rate this

    Comment number 41.

    Glyn T - the problem with the "dispersed Welsh population" argument is, the fact that across the West Country - the Yorkshire moors etc the same issues arise. As you said in an earlier post, devolution hasn't worked. Health or lack of it is a UK wide issue and would be better tackled on that basis

  • rate this

    Comment number 40.

    The problem is while it's acceptable to transfer patients needing highly specialised treatment large distances The majority including outpatients need fairly straightforward support.
    Of course it isn't just the patients, Family and friends are important visitors for the sick - try affording visiting regularly if you have a couple of hours drive on poor rural roads in winter.


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