This is the first article of our ten part series looking at the Welsh Government’s progress in delivering its Programme for Government (PfG). Here, we explore the well-being objective to “Provide effective, high quality and sustainable healthcare”.
There are 11 specific commitments beneath this Cabinet-wide objective, which the Welsh Government has given an update on in its PfG annual report. There are also relevant Ministerial commitments.
Browse our full #ProgrammeforGovernment series, published to date.
The ‘healthcare’ objective sets out a number of wide-ranging commitments, including providing treatments delayed by the pandemic and actions to improve mental health (see our recent articles Reducing the NHS waiting list backlog and Senedd focus on mental health for more on these issues).
However, the delivery of the Welsh Government’s healthcare commitments will depend on the availability of a skilled and sustainable workforce.
Workforce pressures was a key area of concern for health sector stakeholders at the start of the Sixth Senedd. Responding to the Health and Social Care Committee’s ‘priorities’ consultation, many highlighted the impact of the pandemic on an already-stretched workforce, and called for action to tackle staff shortages, improve recruitment and retention, and address equality and diversity issues.
Workforce issues have continued to be raised throughout the Committee’s programme of work to date, including in relation to: the waiting times backlog (2022); hospital discharge (2022); mental health inequalities (2022); endoscopy services (2023), and dentistry (2023).
With mounting pressures on NHS services and staff wellbeing at an all-time low, some healthcare professionals have taken strike action in recent months, as part of ongoing disputes about fair pay and patient safety.
What does the Programme for Government say about the workforce?
The Programme for Government (PfG) promises to “deliver better access to doctors, nurses, dentists and other health professionals”, and includes a specific commitment to establish a new medical school in North Wales.
In its annual PfG progress report (published July 2023), the Welsh Government highlights its work to reform contracts with dentists, community pharmacies, and GPs. It describes the new GP contract as “the most significant reform in 20 years”.
In relation to the North Wales medical school, the Welsh Government says “substantial progress” has been made and that the school is due to take its first direct intake of students in autumn 2024. It says intake numbers will gradually increase until the school reaches full capacity (of 140 students per year) in 2029.
The annual report also highlights £5m investment to increase the number of community-based allied healthcare professionals (such as physiotherapists and occupational therapists). The Chartered Society of Physiotherapy welcomed the focus on community-based services, but emphasised the need for greater support for allied health professionals already working “under huge pressure” in the Welsh NHS.
In a March 2023 statement on access to primary care services, the Minister for Health and Social Services acknowledged the demand for primary care services outstrips capacity, making improved access to health professionals challenging. For further information on primary care reform, see NHS Wales’ Strategic programme for primary care.
The PfG also commits to continued funding for the NHS Wales bursary. In April 2022, the Minister for Health and Social Services announced that the existing package of support for healthcare students would be extended for the 2023/2024 academic year, and that a consultation exercise will be carried out regarding future support. The Minister has subsequently indicated that a timeline for the consultation will be set out in September 2023.
Where are some of the workforce pressures?
The PfG progress report states that almost 174,000 new patients have gained access to NHS dental care over the last year. However, a key concern among stakeholders is that there’s no clear picture of how many people in Wales are still waiting to see an NHS dentist. The Senedd’s Health and Social Care Committee found there are also significant inequalities in access:
Inevitably, it is those who are most in need of services that are least able to access them.
The Committee called on the Welsh Government to explore options for a centralised waiting list in order to better understand demand, and target resources where needed. The Welsh Government accepted this recommendation.
The Committee’s report also highlighted concerns about a lack of workforce data. In its response to the Committee’s report, the Welsh Government indicated that a dental workforce strategy would be published in July (not yet published at the time of writing).
In March 2023, the Health Minister told Members of the Senedd that, under the reformed contract for community pharmacy in Wales, pharmacists are now able to prescribe and supply medicines for an extended range of conditions:
…providing increased access to services for the public, and relieving pressure on GP and other NHS services.
See the Welsh Government’s A new prescription policy document (December 2021) for more about pharmacy contract reform.
It's been a long-held ambition for pharmacy to make a greater contribution to improving health and wellbeing, however this part of the workforce is also experiencing pressures. Community Pharmacy Wales reports pharmacist shortages in all parts of Wales (this was historically an issue in more rural areas). It highlights a more general shortage of pharmacists in the UK, beyond community pharmacy, and that the role of pharmacists has now been added to the Home Office’s shortage occupations list.
In 2019, the Welsh Government agreed that GP training numbers should increase to better reflect population numbers in each health board area. The target became to recruit 160 GP trainees per year, up to a maximum of 200 if there are sufficient numbers of eligible candidates.
Health Education and Improvement Wales’ (HEIW’s) Education and Training Plan for 2023/24 says the number of GP trainees has steadily increased since 2019, but that the profile of trainee cohorts is changing. It highlights that doctors are also now on the shortage occupations list, and that increasingly high numbers of GP trainees are international medical graduates (IMGs):
For example, of the August 2021 and February 2022 intake, of a total of 184 total trainees 54% were IMGs. Indications for the August 2022 and February 2023 intake is that the number of IMGs will be high.
This is a wider issue in the UK. The General Medical Council states that IMGs now outnumber UK graduates in applications to join the UK medical register. It also reports that IMGs too often have a poorer experience of medicine than their UK colleagues, feeling excluded and unsupported throughout their education and careers.
While our healthcare systems are leaders in the diversity of their staff, they cannot boast such credentials when it comes to inclusion.
Inclusivity is a central theme in Wales’ workforce strategy for health and social care – “Creating a culture of true inclusion, fairness and equity across our workforce will be at the heart of this strategy”. As highlighted in the strategy, workforce inclusion, engagement and wellbeing is directly linked to the quality of care experienced by patients.
The PfG annual report makes limited reference to nursing, yet this is the largest NHS workforce group - nursing, midwifery and health visiting staff make up 40% of the NHS Wales workforce.
There have been long-standing concerns about nurse recruitment and retention. The nursing shortage is a global issue. Other countries are also seeing high numbers of vacancies, and a growing reliance on agency staff and international recruitment to fill posts. You can read more about the nursing workforce in our February 2023 article Is nursing a workforce in crisis?.
Ensuring a sustainable supply of nurses was always going to be key to realising the ambitions of Wales’ nurse staffing levels legislation. The Health and Social Care Committee is currently carrying out post-legislative scrutiny of the Nurse Staffing Levels (Wales) Act 2016, to look at how well the Act is working in practice and its potential future development.
Focus on retention
The Welsh Government’s National workforce implementation plan (January 2023) recognises that improving retention – keeping experienced staff in the workforce – is arguably one of the most important challenges to address:
We cannot simply recruit our way out of the situation […] It will remain vital to support the health and wellbeing of our existing workforce, focus on retention of our workforce and ensure that we develop the skills and capabilities needed for the future.
The First Minister said that the Programme for Government is, first and foremost, about recovering from the pandemic, and ensuring the NHS can care for everyone who needs it. Sustainable staffing solutions will be key to this. As the Health and Social Care Committee has repeatedly heard, “no amount of extra funding will be able to tackle the patient backlog if you cannot find the workforce”.
Explore the Programme for Government, its objectives and commitments
- 1. Provide effective, high quality and sustainable healthcare
- 2. Protect, re-build and develop our services for vulnerable people
- 3. Build an economy based on the principles of fair work, sustainability and the industries and services of the future
- 4. Build a stronger, greener economy as we make maximum progress towards decarbonisation
- 5. Embed our response to the climate and nature emergency in everything we do
- 6. Continue our long-term programme of education reform, and ensure educational inequalities narrow and standards rise
- 7. Celebrate diversity and move to eliminate inequality in all of its forms
- 8. Push forward towards a million Welsh speakers, and enable our tourism, sports and arts industries to thrive
- 9. Make our cities, towns and villages even better places in which to live and work
- 10. Lead Wales in a national civic conversation about our constitutional future, and give our country the strongest possible presence on the world stage
Article by Philippa Watkins, Senedd Research, Welsh Parliament
