Welsh health service is "unsustainable," report says
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《英国医生杂志》
Urgent, radical, and sweeping changes to health services in Wales are being urged by the Audit Commission.
A catalogue of problems identified in a new report include more than one in four beds blocked by patients who should not be there, poor use of resources, alienated clinicians, considerable overspending, and management weaknesses.
Day surgery and theatres are poorly used, beds in community hospitals are underused, and more progress is needed in public health.
"The challenges faced by all those concerned with the health of Wales and its people are daunting. Overall, the picture in Wales is one of an unsustainable service. Welsh comparative performance for length of stay, day surgery, availability of diagnostic support services, theatre utilisation and use of community hospitals are all less than optimal and worse than what is realistically achievable," says the Audit Commission in Wales report, Transforming Health and Social Care in Wales.
The report says that although Wales received 30% more funding between 1999 and last year, the Welsh NHS deficit more than doubled.
"Although the health service in Wales will continue to need the additional resources already allocated to it, and the further planned extra finance, increasingly the issue is that the money is not being used effectively," says the report.
At one trust the commission identified potential savings of almost ?0m ($71m; �60m) a year by reducing the number of admissions from accident and emergency departments, reducing length of stay after surgery, removing the "weekend effect" by making diagnostic services available over the weekend, and improving performance in day surgery.
On management, the report says, "There are weaknesses in some areas of NHS management, as shown in failures to implement action plans, ongoing financial deficits, remedial actions that do not address causes, insufficient strategic capacity, and lack of pro-activity."
On bed blocking, it says that Wales has more beds per head than England but admits more patients who don抰 need to be there. A quarter of Welsh beds are blocked by delayed transfers and delayed discharges and 17% of Welsh beds are occupied by patients who do not have to be in the acute sector.
"The main problem is not necessarily that the Welsh people are 憇icker?than elsewhere but that the whole system of health and social care is not organised to best effect," it says.
The report also warns of doctors becoming alienated: "Many clinicians are cynical about change and alienated from a system in which they see money rather than quality or need as the main driver. Thus, service improvements achieved by clinicians are often perceived (and often rightly) as a means to reduce deficits."
The director general of the Audit Commission in Wales, Clive Grace, said that recent signs of reductions in waiting list figures were welcome but added, "The current situation is a manifestation of deep seated system problems—national, local, political, managerial, and clinical. That is why we see the responsibility for solving these problems as equally wide ranging—and urgent. We want to get across how services need to change to deliver the healthcare system which Wales deserves."(Abergavenny Roger Dobson)
A catalogue of problems identified in a new report include more than one in four beds blocked by patients who should not be there, poor use of resources, alienated clinicians, considerable overspending, and management weaknesses.
Day surgery and theatres are poorly used, beds in community hospitals are underused, and more progress is needed in public health.
"The challenges faced by all those concerned with the health of Wales and its people are daunting. Overall, the picture in Wales is one of an unsustainable service. Welsh comparative performance for length of stay, day surgery, availability of diagnostic support services, theatre utilisation and use of community hospitals are all less than optimal and worse than what is realistically achievable," says the Audit Commission in Wales report, Transforming Health and Social Care in Wales.
The report says that although Wales received 30% more funding between 1999 and last year, the Welsh NHS deficit more than doubled.
"Although the health service in Wales will continue to need the additional resources already allocated to it, and the further planned extra finance, increasingly the issue is that the money is not being used effectively," says the report.
At one trust the commission identified potential savings of almost ?0m ($71m; �60m) a year by reducing the number of admissions from accident and emergency departments, reducing length of stay after surgery, removing the "weekend effect" by making diagnostic services available over the weekend, and improving performance in day surgery.
On management, the report says, "There are weaknesses in some areas of NHS management, as shown in failures to implement action plans, ongoing financial deficits, remedial actions that do not address causes, insufficient strategic capacity, and lack of pro-activity."
On bed blocking, it says that Wales has more beds per head than England but admits more patients who don抰 need to be there. A quarter of Welsh beds are blocked by delayed transfers and delayed discharges and 17% of Welsh beds are occupied by patients who do not have to be in the acute sector.
"The main problem is not necessarily that the Welsh people are 憇icker?than elsewhere but that the whole system of health and social care is not organised to best effect," it says.
The report also warns of doctors becoming alienated: "Many clinicians are cynical about change and alienated from a system in which they see money rather than quality or need as the main driver. Thus, service improvements achieved by clinicians are often perceived (and often rightly) as a means to reduce deficits."
The director general of the Audit Commission in Wales, Clive Grace, said that recent signs of reductions in waiting list figures were welcome but added, "The current situation is a manifestation of deep seated system problems—national, local, political, managerial, and clinical. That is why we see the responsibility for solving these problems as equally wide ranging—and urgent. We want to get across how services need to change to deliver the healthcare system which Wales deserves."(Abergavenny Roger Dobson)