Doctor Iain Robertson-Steel, who retired as Hospital Director at Withybush earlier this year, shares his thoughts on how to create a sustainable future for the NHS in Pembrokeshire.

THE NHS is now 70 years old and faces greater challenges and demand than ever before.

Identifying the scale of the challenge for the future of health and social care and addressing how services can be effectively delivered and funded is vital if the needs of the population are to be met.

There has been a great deal of debate around the provision of healthcare in Pembrokeshire, focusing primarily on the future of Withybush District General Hospital.

The problems facing Pembrokeshire are part of a much bigger picture.

There is a crippling shortage of staff, particularly GPs and primary care teams and providers of social care.

Improving healthcare and social services in Pembrokeshire can only take place if central government makes national changes to address structural and organizational problems.

Hywel Dda University Health Board has been blamed for attempting to downgrade Withybush and remove services from Pembrokeshire.

The real accountability for the current situation in Pembrokeshire and Wales as a whole, lies with the Welsh Government and the party that has been in power for over a decade: the Labour Party in Wales.

Across Wales, services are deteriorating. Winter 2017/18 was the worst for A&E delays, patients waiting in Ambulances, cancelled operations.

 

Hospitals like Withybush are facing constant winter pressures.

This winter will be even worse, the NHS faces ‘continuous winter pressures’. Staff are exhausted, working long hours, and in excess of their contracted days.

Board management teams are harried by ‘holding to account meetings’ and unremitting pressure from government.

Without adequate resources, staff and the ability to work together as single health and care teams it is wrong to blame NHS and Local Authority staff and management.

Government is responsible for funding the NHS and social care through health boards and county councils.

Government is responsible for policy and for setting the national agenda.

Most importantly, government is responsible for the recruitment of doctors, nurses, social workers and the many frontline staff who deliver care.

The government has failed to reorganize health and social care services to encourage working together and simplifying service delivery.

Running a health service in a coastal and rural area is impossible without staff.

Health services in Pembrokeshire are at risk due to a serious shortage of doctors and nurses. Similarly, social care cannot work effectively without skilled carers.

Pembrokeshire County Council and the health board have difficulty working closely together due to the fact that they are separate organisations, with their own objectives, budgets and targets.

 

Sir William Beveridge, the economist who wrote a report which was the basis for the Welfare State.

Beveridge (1942), the architect of the Welfare State unfortunately didn’t sit down with Bevan (1948), the father of the NHS and the two services have failed to work effectively together since.

Duplication is the enemy of effective services. The problem is even worse in west Wales as Hywel Dda has to work with three county councils.

Government must merge health boards across Wales into three Health and Social Care Boards.

 

Aneurin Bevan, founding father of the NHS.

Each health and social care board should cover 1.2 million people, so Hywel Dda should form a single Western Health and Social Care Board, amalgamating with Swansea.

This HSCB should have three major hospitals; two district generals and one tertiary and teaching centre.

Ambulances and specialist services would be separate boards working on an all Wales basis.

The social care budgets should be removed from councils and placed with the health and social care boards, which would be centrally funded from government on a capitation basis funded through taxation.

Local councils would provide education, roads, planning functions and all the current activities apart from health and social care.

For west Wales there would be one council for Pembrokeshire, Ceredigion and Carmarthenshire and one for Swansea, reflecting rurality and metropolitan roles.

Health and social care would be delivered in Pembrokeshire by local care teams, GPs, Nurses, Social workers, carers, and third sector and volunteers working together.

For Pembrokeshire the case for a new Western District General Hospital with full facilities at Narberth would be greatly strengthened.

However, no change can take place without government making a structural change.

Mark Drakeford has previously been the health and social services Minister and failed to make progress or change.

 

Wales' new First Minister, Mark Drakeford.

He is now the new First Minister and is responsible for the direction and performance of government.

There is a real opportunity to build a National Health and Social Care service fit for the next 70 years, embodying the principles of the founding NHS fathers.

We, the taxpayers, will have to accept the need to pay more taxes to care for the elderly.

As tax payers, we have the right to expect efficient and effective use of our taxes.

Raising council tax is not the panacea and will not solve the problem of lack of social care; the costs will outstrip the ability of council tax payers to pay.

The NHS is about to fail and social care cannot deliver. The economic position is as bad as in the 1930s. The outlook is challenging. Demand exceeds supply and current funding. The position can only get worse.

The new First Minister has to shape up to the challenge.

The omens are not good, in ten years the NHS has declined. Mark Drakeford now has a brief window of opportunity.

Shuffling the chairs in government in the circle of the tired old guard will not produce change.

The people of Wales and the hard-working dedicated staff in health and social care do not need any more procrastination or blame passing.

 

Plans for health care changes in west Wales have led to protests at Withybush.

Pembrokeshire needs GPs, a new District General Hospital at Narberth and integration of health and social care. This is only possible if the government takes key steps, recruits and retains staff and merges services for the future.

Tough and unpopular decisions need to be taken, not glitzy new acts and objectives without funding.

Only government can enable change to take place, the Health Board and the local councils have their hands tied at present by old and outdated structures which are not fit for purpose.

The responsibility is Mr Drakeford’s.

We must hold him accountable as First Minister.

The three million people of Wales need new leadership with vision, resilience and determination to make change for the future in difficult times.

A consensus plan for the future of Health and Social Care is essential.

Our county is part of the bigger national picture and we can only improve care by being part of a greatly improved national model for Health and Social Care.