My NHS struggle: One year later

Rajan Madhok

It was in Oct 2024 that Nation.Cymru published my first report on the NHS is Wales. A year later, during which I have written several articles, and engaged with as many senior NHS leaders and politicians as I can, I am wondering what was the point of my efforts?

I cannot assess whether services have improved as I do not have comprehensive evidence, but my personal observations and experience tell me that there is a long way to go to ensure timely and effective patient centric NHS and care services.

My efforts have failed to engineer any serious discussion or action, rather I have been left feeling ignored, ostracised, patronised, with occasional supporting noises, and been passed from one to the other, and then forgotten.

Urgency

There has been no sense of urgency, or about taking responsibility about the issues I have highlighted.

To some extent, this was not totally unexpected, but what puzzled me were two things: one, almost everyone that I spoke to, after the first article, could recount similar tales of poor experiences- “you have written about four people, but there are hundreds and thousands of people in the same situation all over Wales” and  “it happened to my husband, wife, parents etc”; and two, acceptance and helplessness with that is how it is and nothing can be done, so essentially suck it up. These latter comments were not from Joe Public but senior people in the health and care system. When they would tell me about their personal (poor) experiences, I used to look at them, wondering if they were hearing themselves- they were the leaders, it was their job to sort things out. I was not talking about someone else, but about everyone including them- this is what we will get if and when we need the NHS and social care.

Yes, some of them will be able to avoid it with their money or connections, but only for some of the time, but money certainly will not help as there are no private emergency hospital services.

I have not been taking shots at anyone or scoring points – we are all party to the current situation and can choose to be the problem or the solution. I have also given credit where credit is due – indeed that is what keeps me going, because I know there are good people and it is possible to do better.

My overall assessment is that solving the problems of the current health and social care system is not about changing the government; reorganisations or breaking up the Board in North Wales for example; more money and professional staff and less managers; more think tanks, ministerial advisory groups, working parties, or technology; more special measures and paperwork; blaming each other including  troublesome and time-wasting patients, for two reasons. One, focussing on one aspect alone will not solve the current problems – it may be necessary to fix all of them in different proportions but as part of an overarching plan led by good leadership, and two, there is a danger of getting distracted- the problems are here at present, not in the future, and we must do something, now.

People can disagree with my assessment, in fact it is important to do so since it may improve the outcomes, but not to put up equally considered counter-proposals or act on the problems does not sit well with me.

Solutions

The tragedy is that there are solutions. Let us take one specific example: the A & E Department at Glan Clwyd Hospital, the subject of my last article, where the Matron was clear that the service was not acceptable, and things were the way they were because no one was taking responsibility to sort them out – “it is a broken system, we know what needs to be done, but it is not being done.”  Why could my friend not   have gone home and come back next morning- retired, recently widowed, just told of his own diagnosis with widespread cancer, left in the busy A & E overnight in a wheelchair, and who was neither seen nor treated during the night? It seemed to me during the time I spent in the Department with him that no one was thinking there- the staff were too busy in a badly organised system, sleep walking (working) through it.

They had forgotten the patient, the human being at the centre. And there are so many small things which can make big differences to patient, and indeed staff, experience. Do the small things and big changes will come; Gwnewch y pethau bychain, said Dewi Sant.

But, what will it take to get services to improve, I wonder? Some of my well-wishers have cautioned me about ‘making noises’- Wales is a small country and everyone knows everyone else at the senior levels, and you will be hurt they tell me. I am also told that Wales is a small-minded country (not my words), as an outsider you will not be welcome, there is no ambition or encouragement, and innovation is discouraged- lot of talking yes, but doing no.

I do not believe either is correct; the Wales I have come to know, and love, in the last seven years since I moved here is different: there will always be ‘small’ people but there is a lot of talent, potential, commitment and community spirit, and some good foundations to build on. But turning this into real improvements is the challenge.

Futility

What do you advise I can, should, do now? With my bereavement on top of my experiences especially my friend’s recently I am partly depressed with the futility of my efforts and partly more determined. But this is not a job for one person, it needs more people to add their voices – “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has,” (Margaret Mead). But where are they, and how can we all work together? All advice welcome.

May be the thoughtful, committed people at BCUHB (of which there are some) can come together, focus on the A & E Department at Glan Clwyd, set out a clear plan of action to address the well-known small issues affecting patients there, and ensure that the coming winter will be of content (not discontent).

And maybe they can show their commitment by spending time in the A & E Department observing, not just doing walkarounds or passing through (and yes, I have seen the Ysbyty S4C programme episode) but being there, seeing what goes on, and talking to the patients, spending an evening, and preferably overnight there? Maybe it should be mandatory for every board level person to do so?

And if they start, help will arrive, as there are people who do not want to be complainers but want to use their knowledge and experience to help improve services. I am not alone in wanting to help, there are others– please use us. The force will be with you then.

Rajan Madhok is a retired public health doctor

Rajan has written this article in his personal capacity. More details of his work, including his Welsh journey, are available at www.ramareflections.com