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How can we help to futureproof our NHS in Wales? Dr Rob Orford, Chief Scientific Adviser for Health at Welsh Government discusses his new advice paper and how we can best organise available resources to maximise impact and overcome the many pressures it faces.  

Blociau adeiladu fertigol gyda llun o fwlb golau ar y gwaelod, cogiau yn y canol a tharged ar y brig

I recently published an advice paper to Welsh Government to support thinking around the NHS in Wales going forward. Our much-cherished establishment is now 75 years old and facing many pressures: from an expanding and ageing population that increases demand for health and social care services to a recent global pandemic that we are still recovering from. 

Now is therefore an opportune time to review the evidence base to inform our critical thinking. How can we best organise our available resources to maximise their impact on the health and wellbeing of our future generations?   

What does the paper explore? 

This advice paper will be an opportunity to consider taking a transformative approach to NHS planning in Wales. I see four key themes: 

  • Firstly, with an ageing population some of what is coming down the track is inevitable; as people live longer, the prevalence of certain conditions will increase. The system needs to adapt to cope with these projected needs, switching emphasis to a more personal and integrated care package. 
  • Secondly, many long-term conditions (LTCs) are preventable. We should therefore place a higher emphasis on working with the public to support proactive self-management of their own health. But also coupling this with broader action to address wider determinants of health through evidence informed policy. We cannot expect the public to do all the work. 
  • Thirdly, tackling poverty and health inequalities will be essential for other public health interventions to succeed. We cannot ignore that the prevalence of LTCs is projected to disproportionately affect our most deprived population groups. We need to think beyond the NHS when considering health to make significant changes to health outcomes. 
  • Finally, we need to generate value. Efficiencies across the NHS will come from active pursuit of value through evidence informed technology. But we also need to explore other avenues and not just hospital flows to improve efficiency. This should include thinking of the NHS as an economic powerhouse for Wales.  

Whatever action we do decide to take, we need to start doing it sooner rather than later to preserve the NHS for future generations and make sure we can all live innovative, happy, healthy and rewarding lives. And in doing so, we need to take the public and our NHS workforce on that journey with us.  

This advice paper, collated by my Science Evidence Advice team, has been heavily informed with literature projections. Primarily from a rapid evidence map compiled by the Health and Care Research Wales Evidence Centre and also modelling of specific diseases and services by Public Health Wales (PHW). In presenting this advice paper we acknowledge that this is an extensive subject with an evolving evidence base – particularly when it comes to technological developments – and the content presented is what was available at the time of collating the report. 

It is important to note that the report is not exhaustive; it considers some diseases that are major causes of morbidity and mortality but there are many other diseases that could be further considered and other risk factors that could be explored in detail. The scope of the report is limited to health service-related factors, but we of course know that health outcomes are determined by a wide range of determinants.

What are our partners saying? 

There’s similar thinking from others in Wales and across the UK in this space. We have included projections on diabetes and NHS hospital beds from PHW but these are just one part of a portfolio of projections of the prevalence of disease out to 2035 that colleagues in PHW are working on. This broader work is available later this year and will also look at cardiovascular disease, mental health, musculoskeletal disorders and obesity amongst other conditions. 

The Health Foundation published a paper in July which looks at the projected patterns of illness in England to 2040 and presents overall similar findings to our report where the same conditions have been examined albeit through different analytical approaches. This work explores a broader range of risk factors that includes alcohol consumption and physical activity which will be useful to policy makers. 

In 2016, the Academy of Medical Sciences called for all those working in fields that affect human health to come together and work with the public to significantly enhance the health of the population by 2040. The Academy recently published updated priority areas for action in light of changes to public health structures in the UK and complex challenges that have come to the fore. These include increasing inequalities, emerging infectious diseases and the climate crisis. Other estimates and evidence on projected demands for the NHS will therefore be available and these may yield different results to the SEA report, but it all adds to provide a rich tapestry of evidence to support science informed policy making that I wholly champion.  

It is with great thanks to all my colleagues who have helped to shape this paper that I share this advice. I hope it stimulates discussion and forward thinking to address the challenging landscape of today and years to come. 

To read the paper in full please visit Welsh Government website

For all enquiries, please contact  

Dr Rob Orford is the professional lead for healthcare scientists in NHS Wales. He provides specialist technical and scientific health advice across a range of health sciences and health protection areas. He is a member of the National Diagnostics Board, UK Genome and UK Life Science Advisory Board.