NHS at breaking point - patients and workers in Wrexham and Flintshire speak out

Steve Craddock speaks to those who have experienced the crisis first hand as patients, and those working in the field about where the problems lie, and possible solutions...

Susan Perry, Group Editor Newsquest North Wales, recently experienced the stretched NHS firsthand...

Our health service needs healing.

It is in desperate need of some urgent care and attention.

Having recently broken my foot, I cannot praise enough healthcare staff.

I attended the minor injuries unit at Mold Community Hospital, followed by a visit to the fracture clinic at Wrexham Maelor.

I am going to be honest, I did not seek attention for my injury soon enough, basically because I have read the horror stories in our paper about waiting times in A&E and minor injuries, and I had hoped my injury would heal itself without me having to seek medical attention.

As it turned out it didn’t and I have fractured my navicular bone in my left foot and am now in a cast.

When I did finally attend minor injuries in Mold, it was at bang on 8.30am when it opened and there was already a queue.

This comprised of people who had been unable to be x-rayed the day before, as that department closes at 4pm.

I was seen within half-an-hour by a triage nurse, who said I would need an x-ray.

Half-an-hour later I had my x-ray but waiting for the results proved to take more time, as more and more people started to arrive needing treatment.

In that waiting time I watched as the queue got bigger and the two nurses on duty having to deal with the increasing number of patients were run off their feet.

An elderly couple came in, the gentleman had had a fall, they were told the wait would now be at least two hours.

The A&E department at Wrexham Maelor Hospital

By the time my results came, the waiting room was heaving and I overheard the nurse saying that despite their official closing time of 6.30pm, she had worked until 9pm the night before.

As I had suffered a fracture I was told an appointment would be made for me to attend fracture clinic in Wrexham the next day.

I left Mold minor injuries at 11.45am, just over three hours after I arrived.

My appointment for the fracture clinic at Wrexham was phoned through to me later that afternoon and so the next day I was off to the Maelor.

The first thing that hit me, like we have reported many times in the Leader, was a lack of parking.

It was a nightmare, with cars queueing and motorists hoping that somebody would be leaving so they could nip into their space.

Luckily I was being dropped off but at 9am there were no available parking spaces.

Once again the care I received, like at Mold, was faultless.

I was taken through to see a doctor, diagnosed with a fractured foot and sent to be plastered!

But again the corridors and waiting areas were heaving with people needing attention.

The medical staff were run ragged but their standard of care did not dip.

Basically they are understaffed. They need more nurses not more managers. People are having to go to minor injuries and A&E because they cannot get appointments at their GP surgeries, as there were simply not enough GPs either.

To a layman like me I think the NHS needs a massive recruitment drive to get more doctors and nurses. The money they appear to be using on managers, who are paid to tell them they need more staff, is ridiculous.

We also need to educate people on whether a trip to the doctor or minor injuries is necessary.

There are plenty of chemist shops on our high streets, where pharmacists are more than capable of discussing minor illnesses. It would save you a trip to the doctor and take a bit of pressure off our already fragile heath service.

We recently carried a story about Buckley councillor Carol Ellis, who witnessed herself the horrendous pressure the A&E department at Wrexham was experiencing, after her husband was taken ill.

Some people criticised her for only appearing to care when the issue affected her but speaking as somebody who has seen it for themselves, until you have been through it, you cannot begin to describe the vast problem our health care providers are facing on a daily basis.

The health authority often describes it as ‘unprecedented’ numbers but I would say these unprecedented numbers are now occurring far too often.

Health board and government response...

Imran Devji, Managing Director of Wrexham Maelor Hospital, said: “A number of factors impact our Emergency Department’s performance, including patient demand, staffing, the way we treat emergency patients within our care, and our ability to move people from the Emergency Department to their next source of care.

“We face the same challenges as the rest of the NHS with national skills shortages and difficulties in recruiting staff. We are working on ways to improve our medical staffing position, both for temporary and permanent positions, and to have a better system in place to cover short-notice absences and staff sickness.

“We’re working on plans to improve the way patients who visit the department are seen. This will help us direct patients to the care they need in a setting other than the Emergency Department, either within the hospital or another location appropriate to their clinical need, providing the staff who work there with additional resources and time to care for other patients.

“We continue to ask for the public’s help to ensure the Emergency Department is only caring for people in need of emergency treatment. Looking at patients who attend our Emergency Department, there is potential for them to be seen in one of our Minor Injuries Units, or at a local pharmacy. The minor injuries units in Holywell and Mold can treat a number of less serious ailments, while other services in the community, including our pharmacies, can provide fast, effective treatment.

“We believe there is potential for us to work more effectively with our partners, to ensure that our patients access the right care, at the right time, in the right place. 

“This would help us improve the rate at which we are able to discharge patients from hospital, which in turn would reduce pressure on our Emergency Department.”

• We are steadily improving in our four hour Emergency Department performance. August 2019 saw a three percentage point improvement on our 2018 performance.

• Against cancer performance, we remain the best performer in Wales.

• We consistently meet the target for red category calls – the most serious incidents of Emergency Department attendances.

• Our performance against one hour ambulance delays improved by 12 per cent in August 2019 compared to 2018, whereas the all Wales figure fell by 68 per cent.

• We recruited 125 newly qualified nurses this month, following completion of their training.

• Our recruitment team attend job fairs in England and Ireland, as well as abroad, to aid recruitment

• Improved offer of flexible working patterns and internal training schemes to develop and increase skills of our existing workforce

A Welsh Government spokesperson said: “We have, under the special measures arrangements, provided managerial and advisory support to the health board together with more than £80million of additional funding. 

“Progress has been made in key areas – maternity services and out of hours services are out of special measures. 

“We expect the board and the leadership team to tackle long-standing issues and improve services for patients throughout North Wales. 

“We are increasing investment in medical training places throughout Wales - over the last five years nurse training places have risen by 68%. 

“We have funded extra places for studying medicine, including places in North Wales for the first time. 

“We are recruiting doctors and nurses from around the world, supported by our Train Work Live campaign. 

“The campaign has also helped fill all our GP training places in North Wales.”

Calls for Flintshire to have its own A&E

FLINTSHIRE is a big enough county to warrant its own equivalent to Wrexham Maelor Hospital, a councillor has said.

The Leader reported recently how Buckley councillor Carol Ellis was left “horrified” after attending the Maelor’s A&E department.

Cllr Carol Ellis

She said her husband - like many people - had to wait on a trolley in the corridor to be assessed by a doctor, staff looked exhausted and there were “so many people”.

Cllr Ellis has now announced that her independent group on Flintshire Council intends to put forward a notice of motion calling on the Welsh Government to hold Betsi Cadwaladr University Health Board to account and sort the situation out.

She said: “Flintshire warrants its own hospital because of the sheer size of the county and the way it is growing.

“It is obvious when you visit A&E that it is not big enough to cope with demand.

“When the winter pressures emerge - which they always do - and the flu is around, that’s when you see scenes like I saw recently.

“But if they can’t cope now, what is going to happen when we actually get into winter?”

Speaking of her group’s plans to hold the health board to account, she said: “We need to keep the pressure on, because I am afraid people are going to start dying unnecessarily, I really am. And I think staff are too.”

'It's now more than difficult than ever to find skilled staff'

STAFF recruitment and retention are the greatest challenges facing hospital services and doctors’ surgeries in North Wales, a health chief has said.

Following the experiences of editor Susan Perry and Buckley councillor Carol Ellis, the Leader spoke with North Wales Community Health Council chairman, Geoff Ryall-Harvey to get his thoughts.

He said: “We have recently undertaken a number of visits to A&E departments across North Wales and the situation described is something which is happening everywhere.

“I would say that the greatest crisis facing the NHS in North Wales is not finances - it is staff recruitment and retention.

“It is now more difficult than ever to find skilled staff and there are GP practices which advertise for two years and don’t get a partner to replace someone who has retired.

“They advertise diligently in all of the professional papers, but they still struggle. 

“These are not unusual problems, but some are heightened in North Wales for a variety of reasons.

“Looking at hospitals - speciality nurses, vascular surgeons and neurological surgeons are difficult to recruit.

“And the issue is not money, because if you look at the health board’s locum bill, while they have brought it down a bit it is still substantial.

“They would much rather spend that money on permanent staff, but they can’t get them.”

Mr Ryall-Harvey said it is also difficult to attract people to train as doctors in North Wales, but he hopes plans for a medical school in Bangor could help to tackle the problem, as well as tackling unemployment in North Wales.

Asked why training as a doctor or a nurse might not be as attractive a career as it once was, he said: “This is not the fault of the Welsh Government, or Betsi Cadwaladr University Health Board - but tuition fees are a big factor and the cost of being an undergraduate.

“It takes a lot longer to become a doctor than, say, an accountant. It’s also well known how difficult it is to be a doctor, with long hours and shift working - you’ll be in your late 20s before you’re earning enough to have a family, and people know these things.

“You need dedication and the same thing applies to nursing - it is not an easy job.

“The recent issues around how shifts are paid at the health board as well; it’s hard to say at this stage but I can’t see how that would help recruitment.”

Mr Ryall-Harvey said he feels the Welsh Government should be thinking about how to encourage more young people to become nurses and doctors.

He said: “This is a multi-faceted and difficult problem and you can’t blame anyone - it is a set of circumstances which have arisen over 20 years.

“If we try to point the finger at any one organisation or department it won’t work. Everyone needs to work together to solve it.

“I think maybe the health minister needs to have a conference or summit meeting on recruitment and retention because we really need to move forward with this.”

Recruitment taking its toll across the NHS, says doctor

THOSE who have come into first hand contact with the pressures facing our health service have had their say, but what do doctors make of the situation?

We spoke with Dr Peter Saul, of Beech Avenue Practice, in Rhos, to get his thoughts on what our editor, Susan Perry, and Cllr Carol Ellis had to say.

“These are signs of the system running too hot,” he said, describing the crowded waiting rooms and staffing difficulties, “and you have to include social care in the mix as well.

“Essentially, hospitals don’t have enough resources in terms of staffing and there are insufficient beds.

“All those beds get full and we don’t have sufficient infrastructure in the community to allow early discharge of vulnerable patients.

“There is not enough capacity in the halfway house between hospital and home, so people turn up at A&E and there’s nowhere to put them.

“That then backs up, the department gets full and there’s nowhere to put the people.

“Then you also get ambulances not able to discharge their patients when they get to the hospital because there’s no space, which then also ties up ambulances.

“The knock-on effect then is that when an ambulance is needed, it potentially takes longer to get there because it is waiting outside a hospital.

“It is an acute situation.”

Speaking of the need for recruitment, he continued: “I have spoken to colleagues at the Maelor and many of them say they’re having difficulty recruiting senior doctors.

“That has a knock-on effect because if you can’t recruit people, others are having to work harder which puts them under more strain and morale takes a knock.

​Dr Peter Saul

“That also affects junior doctors because if the seniors are under pressure, they don’t have enough time to teach the juniors.

“The other thing is the waiting times for surgeries, for example hip and knee.

“For non-acute elective surgeries, I’m seeing patients who are having to wait longer. Some patients are having to wait about a year or more for them - things have not improved and have probably gotten worse in the last year.

“It is absolutely bonkers.”

Describing his view on the way forward, Dr Saul concluded: “We need more recruitment and more resources in the health service.

“We need social care services to take people out of hospitals and we probably also need people to be more realistic about their expectation of the health service.

“It it is something you can deal with yourself or go to the pharmacist for, you should do that.

“People need to be more self reliant and look after themselves better.”