Improving Welsh NHS isn’t just about more money

‘New isn’t always the answer’ and a ‘less is more’ approach seem to be the core messages from last month’s External Ministerial Advisory Group on NHS Wales Performance and Productivity.

Jeremy Miles MS, Cabinet Secretary for Health and Social Care, has resisted the temptation to launch lots of new initiatives, as is the wont of many a politician when faced with an unhappy inbox in a (relatively) new role.

Instead, he has taken the wise step of asking what’s working and what’s not, where and why?  His other wise step was asking a group of experts, with no vested interest, to advise him on practical fixes that can be delivered quickly. There is a Senedd election looming, after all.

A sign of our times is that we are excited not simply by the new, but by the latest version or model.  The new phone with all the new features, even though we ignored most of the features of the last one.  “Why haven’t you upgraded yet?”, is the question posed. “I need this new functionality”, we tell ourselves. As does the NHS. For the health service, it’s a case of new problem – new plan.

I call this NHS Policy Jenga.  We’ll carefully lay a new plan over the last plan, which hasn’t worked to try and address the problem.  And then we’ll do it again. The review says you have a new problem because you didn’t implement the last plan properly, highlighting that the NHS in Wales is very good at strategy and planning, but less good at implementing and monitoring.

The issues with the NHS are almost boringly familiar – record waiting lists, A&E bursting at the seams, ambulances queuing around the block to get in and low satisfaction rates. The review team, led by retired NHS England Chief Operating Officer, Sir David Sloman, set about their task nimbly, quickly visiting all health boards, meeting staff, executives, patients, asking simple questions and seeing if the answers made sense.

Their ‘fresh eyes’ approach and no vested interest stance has allowed them to review and report quickly, with clear recommendations for actions that can be delivered swiftly.

They found big variations that aren’t about funding.  Between December 2023 and June 2024, if every operating theatre had treated the minimum number of patients per list, 632 more joints would have been replaced.  That’s 632 more people with new hips and knees – a 34% increase.  That’s not about more money, staff or equipment, but using what you’ve already got to the minimum standards.  No need for a new plan.

Time and again, the team found the answers locally, but inconsistently delivered.  For instance, if every health board copied Swansea Bay’s University HB’s approach to audiology, where their GPs can decide to refer patients directly to community teams bypassing the hospital altogether, their results, where patients get good outcomes and waiting times are much lower, could be experienced across Wales.

So, when looking at the next objective, challenge or mission by all means look to the new.  But also take a step back to ask “are you using what you’ve got effectively”?  And call on some fresh eyes to help you, because when you are focussing so hard on policy Jenga, one block at a time, you might miss the bigger picture.

This article was written by our director of healthcare, Nick Samuels and featured in the Western Mail on 19 May 2025.