Hospitals & community services - more info

There are 14 NHS Trusts in Wales, most of which provide secondary and tertiary care services as well as community health. NHS Trusts provide secondary health care through hospitals, health centres, clinics and in the home.

The aim for many years has been to ensure that money is spent on the conditions which cause the greatest burden of disease and premature death. Major areas of spend currently include:

Mental health problems

Often seen as the 'cinderella service' of health spend, mental health covers a wide spectrum of conditions and diseases, from depression to Alzheimer's disease. A recent UK survey of mental health showed that around one in six adults require some form of support during the course of their lives. Up to half of these people were seriously ill, but only a quarter of them were receiving treatment for their illness.

Musculoskeletal problems

Disorders include sprains, strains and overuse affecting muscles and joints. They are the most common form of work-related ill health. An estimated 600 children in Wales have arthritis and the self-reported rate of arthritis amongst adults in Wales has been estimated as high as 25 per cent.

Maternity and reproductive health

Over 30,000 babies are born in Wales each year. Just over 2% of births take place at home or elsewhere but all the rest are born in hospital settings which are either in midwifery-led units or consultant units. Until 2005, patients in north, mid and west Wales had no access to IVF (In Vitro Fertilisation) on the NHS. Now all eligible patients will be able to get a free cycle of IVF treatment on the NHS.

Cancers and tumours

Cancer is the single most common cause of death in Wales. In 2004, over 8,300 new cases of cancer were registered in Wales, with prostrate cancer in men and breast cancer in women the most frequent types of cancer detected. Clinical services provided to diagnose and treat cancer have far higher than average health costs.

Circulation problems

In Wales, 13% of people over the age of 16 are being treated for some form of circulation problem relating to the heart and the circulation of blood. Circulation problems account for more than 10% of health spending in this sector. One in four men and one in five women aged 45 can expect to have a stroke if they live to 85.

Respiratory problems

Respiratory medicine is concerned with diagnosis, treatment and continuing care of patients, with a considerable range of diseases and causes including pneumonia, asbestos-related conditions, lung disorders and asthma.
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Primary health services - more info

Telemedicine

It is likely that over the coming decades we'll see the uses of our primary care centres evolve to reflect the general shift from in-patient to out-patient care. Increasingly, specialist diagnosis and treatments will not take place in hospitals but at local community-based centres.

Technological developments will make specialist diagnostic equipment such as X-ray equipment more portable, cheaper and easier to use. It will also result in an increased use of telemedicine (the use of telecommunications technology for medical diagnosis and patient care by a clinician who may be many miles away at the time). This will eventually lead to decentralisation of specialist out-patient clinics. This is particularly important to Wales, with its large and dispersed rural population and long travelling distances to diagnostic centres.

Dental health

In terms of dental health, Wales has a poor record. Currently less than 50% of adults and just under 60% of all children are registered with a dentist. NHS dentist shortages within certain areas have resulted in several cases where hundreds of people have queued for hours in order to register with an NHS dentist.

Prescriptions

Since April 2006, young people aged under 25, together with the anyone over 60 and those with valid exemption certificates and on certain benefits, have been entitled to free prescriptions. The Welsh Assembly Government has committed to abolishing all prescription charges by 2007. In 2005, over 53 million prescription items were approved in Wales - ie nearly 19 prescription items for each and every person living in Wales.

Pharmacies

There are over 700 community pharmacies in Wales and they have seen an expansion in their roles into health promotion. In rural and deprived areas, pharmacies are a vital service to these communities. Many also offer extra services like diabetes care and smoking cessation clinics.

General practitioners (GPs)

There are over 1,800 GPs in Wales. Changes in front-line and specialist care mean that many of the 'chronic' diseases which account for a large and growing proportion of what the NHS does - such as diabetes, respiratory illness, mobility problems, much mental illness - will in future be managed almost entirely in primary care by GPs and their staff.

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Ambulance - more info

In 2004/2005 it dealt with 267,150 emergency calls and its patient transport service carried 1,398,297 non-emergency patients to over 200 treatment centres. In 2005/6, 86% of category 'A' calls (the most urgent) were were reached by the service within the target time, against a standard of 95%.

Ambulance

Ambulance staff undertake pre-hospital interventions that can avoid patients having to attend hospital. This includes administering medical treatments and also liaising with agencies to provide care in the home, thereby avoiding the need to admit some patients to hospital.

Air Ambulance

The Air Ambulance service currently has access to three aircraft. Air ambulances have attended more than 1,500 tasks and carried over 750 patients between 2004 and 2005. Over £2 million a year is required to keep the Air Ambulance in Wales and the trust works with the Air Ambulance charity. This amount will rise considerably within the next few years, as a new generation of aircraft needs to be in service by 2009. back to calculator

Health promotion - more info

Health is worse in Wales than in many other parts of the UK and there are stark geographical and socio-economic variations in mortality rates within Wales. Some of the key determinants of these variations lie outside the control of health services.

Some of the main causes of ill-health in Wales are preventable and heart disease, and diabetes and many cancers, for example, are all influenced by the way we live. Action to prevent ill-health occurring in the first place, not only reduces people's distress but also helps to reduce pressure on limited health care services, allowing them to operate more effectively.

Many of the health promotion programmes require sustained funding over several decades before any improvements in public health could be seen. Gradually however, health in Wales is improving as fewer people smoke and more people understand the need to eat healthier food and take exercise. Can this trend be maintained?

Campaigns and preventative measures include:

The National Flu Campaign

The campaign aims to raise awareness of the availability of the flu vaccine and give general information on the effects of flu.

Over 63% of people aged 65 or more in Wales were immunised against influenza but only 25% of people under aged 65 and categorised in the 'at risk' group in 2004-2005. It is estimated that, if all older people in Wales were vaccinated, around 250 additional lives might be saved each year.

Binge drinking

Over 48% of males and 33% of females aged 16 and over regularly consume alcohol above the daily recommended guidelines in Wales.

Increased health risks include: raised blood pressure which increases the risk of strokes; stomach disorders; depression; cancers, particularly of the mouth, throat and gullet; hepatitis and cirrhosis of the liver; accidents, at home, at work and on the roads; and suicide. Almost a quarter (23%) of 11 to 15 year olds say they drink alcohol and, for the first time girls are drinking as often as boys.

Smoking

Smoking is the greatest preventable cause of premature death and ill-health in Wales, causing around 6,000 deaths each year.

Most die from one of the three main diseases associated with cigarette smoking: lung cancer, chronic obstructive lung disease (bronchitis and emphysema) and coronary heart disease. Currently 27% of males and 26% of females over the age of 16 smoke.

Obesity

In Wales 55.2% of adults are overweight or obese. Obesity is the second largest cause of cancer after smoking. The problems of childhood obesity are already beginning to affect society as a whole. If the current trend of childhood obesity continues to rise, 1 in 4 people in the UK will be obese by 2010. Associated health problems include coronary heart disease, diabetes, kidney failure, osteoarthritis, back pain and psychological problems.

Sexual health

Teenage conception rates in Wales are falling, since their peak in 1998. However, diagnoses of some sexually transmitted infections (STIs), such as chlamydia, gonorrhoea and syphilis are on the increase, with rates highest in young people under 25. If left untreated, the consequences of such infections can be severe and cause serious chronic illness and infertility. In Wales, cases of diagnosed HIV continue to rise, with an increasing proportion infected through heterosexual sex.

Childhood immunisation

Estimates vary, but as many as 50 children under two lose their lives from serious pneumococcal infections in Wales and England each year. Pneumococcus is a bacterium (germ) which can cause pneumonia, meningitis and other infections and routine childhood vaccination programmes have been effective in protecting children from serious disease.

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Management & IT - more info

In Wales, there are 130 hospitals, over 350 health centres and clinics, 90 ambulance stations, and various administrative and support facilities that are used by nearly 90,000 people a week.

Management

A recent ICM poll suggested that the majority of the public thought that managers made up over 20% of the NHS workforce. In fact, managers make up around 3% of this workforce. Health care facilities cost money to run and maintain - money which might be better used caring for people in other ways. Managers need to be in a position to forecast and respond to the health needs of patients.

IT

The NHS in Wales runs an Information Technology project called 'Informing Healthcare'. Separate from the controversial IT programme in England, this scheme hopes to roll out a number of initiatives. These include providing IT equipment and training to health service staff, creating personal health records for patients and piloting systems aimed at proactively monitoring patients with specific conditions in their own homes.

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