A leading Accident and Emergency consultant has warned that casualty departments across Wales are on the brink of disaster.
Dr Robin Roop, who heads the Royal College of Emergency Medicine in Wales, has said that accident and emergency units are “on the edge”. His claims have been widely reported in the Welsh media in the last week and include the suggestion that not a single A&E department in Wales had enough consultants to meet the Royal College's minimum recommended staffing levels last year.
Dr Roop's comments were made in the same week that figures revealed following a Freedom of Information request showed that lack of consultant cover in Accident and Emergency departments in Wales is at a “dangerous” level.
RCEM guidelines say 10 consultants should be working every day in emergency departments in Wales. But Morriston Hospital in South Wales had the only emergency department in Wales that met the target. Hywel Dda Health Board was the worst performing, with Prince Phillip Hospital in Llanelli achieving just 10% of the RCEM baseline.
And the situation was no better in North Wales where figures revealed that Ysbyty Glan Clwyd’s A&E operated at 70% below the minimum suggested by the RCEM.
Just three “whole-time equivalent” consultants were available at the Bodelwyddan hospital in the first week in June while there were just four working in Ysbyty Gwynedd, Bangor and six in Wrexham Maelor.
Whilst the figures do not include any locums working in the departments during the period they do demonstrate the huge challenges facing emergency departments in Welsh hospitals and help to explain why performance against the Welsh Government's targets is poor.
Dr Roop has also expressed concerns over the shortage of senior doctors and emergency unit nurses and there can be no doubt that these staffing gaps are adding to pressures on frontline NHS staff and undermining morale.
For such a senior doctor to speak out in this way is a damning indictment, and it is clear that a failure to undertake effective workforce planning in Wales over the past decade, along with record-breaking budget reductions are now taking their toll.
But Dr Roop's comments should not have come as surprise. The RCEM has previously warned that insufficient staffing levels, under-funded emergency departments and overcrowded wards are compromising safe and reliable care for patients in Wales.
A recent report stated: “Our Members and Fellows tell us that they are being worn down by the relentless workload in understaffed and crowded emergency departments. There is a significant clinical and professional dissatisfaction as a consequence of working in facilities where the desired quality of care is difficult to deliver because the team is under-resourced.”
Meanwhile, the British Medical Association has said the NHS in Wales is running at considerable capacity every day of the year and with the current staffing shortages is struggling to deal with the increasing levels of demand. There is no doubt that closing minor injuries units across Wales has added to the pressure in our emergency departments and therefore undermined staff morale.
With this acute shortage of consultants, middle grade and junior doctors across Wales, it’s not surprising that waiting lists are getting longer and that the target for the number of people waiting for longer than they should be in A&E hasn’t been met since 2009.
It just isn't fair that patients in Wales are twice as likely to wait beyond four hours in an emergency department compared to those over the border in England. The simple fact is, until we have enough doctors to treat sick patients, waiting times will continue to rise and further lives will be put at risk.
It is the failure of successive Welsh Governments to plan effectively for the staffing needs of our health service that has gotten us into this mess and Ministers must act now to get us out. They must to implement measures to ensure that our hospitals have the right people, with the right skills, to meet demand.
Existing Welsh Government recruitment campaigns, such as Work for Wales, whilst noble in their intentions, have done little to alleviate workforce challenges and some Welsh health boards are currently spending massive sums on locum and agency staff which is tying up cash that could be better spent on improving patient care. Relying on agency and temporary staff is not a sustainable solution to recruitment and retention problems in our hospitals and is more costly than employing permanent staff.
Confidence in the Welsh NHS has been diminishing for years and these latest findings will be of great concern to patients across the country. The Welsh Government need to be working with local health boards to address not just the recruitment, but also the retention, of key personnel within accident and emergency departments across Wales so that progress towards the recommended staffing levels can be met. Regrettably, there is little evidence that such action is being taken.