It’s late December 2022 and Wales has just gone through the worst pandemic since 1918 and staff on the front line of the NHS are exhausted. The last thing they wanted was unprecedented demand for their services being caused by a resurgent influenza virus.

Move forward two years, to December 2024 and again we see ‘unprecedented’ demand caused by the triple impact of the influenza, RSV and COVID-19, viruses. As a frontline doctor and epidemiologist, I know that, on both occasions, outlined above, the demand we saw was not unprecedented and, in my long career, I had seen many more challenging times caused by respiratory infections, which I have spent my life researching.  However, in recent years, things have been different, something has changed, it is not the demand that becomes unprecedented but the ability of our broken NHS to cope, resulting in a healthcare system failing at all levels.

In the past two weeks we have learnt that, in Wales, ambulance response targets, for the most urgent cases, have not been met for many years, while a recent survey, published by the Royal College of Emergency Medicine, has found that ‘corridor care’ is endemic in all our major emergency departments in Wales, resulting in patient harm and loss of life. The dangers of ‘corridor care’ were recently highlighted by a Royal College of Nurses’ campaign, endorsed by the BMA – they called for the practice to stop.

Last week the CEO of the Welsh Ambulance Service, while acknowledging the dire state of ambulance response times, seemed to suggest these targets were not necessarily useful today as technology had moved on and the increased number of paramedics were now able to carry out more complex care at the scene. While the later part of this statement is true, the reality is that, on far too many occasions, when I'm dealing with an acutely ill patient in the community, I am not able to get an ambulance. Often, in these situations, the ambulance service is in ‘high escalation’ and my patient falls into the ‘no send’ category, meaning no ambulance being available. Often, this has resulted in an undignified, unsafe, situation where myself and patients’ relatives, have had to carry their loved ones into a car for transport to hospital.

The Labour government in Westminster, on election, recognised that, nationally,  the NHS was broken, yet this should come as no surprise to anyone, it has been brought to its knees by  a perfect storm caused by many years of underfunding, lack of strategic planning, lack of a realistic programme of training and recruitment of doctors and nurses and failure to adequately support social care, particularly for the elderly and infirm.

Today there are less than half of the acute hospital beds that were available 30 years ago, less GPs than 10 years ago and the number of doctors per head of the population, in the UK, is less than most developed economies. This lack of system resilience results in corridor care and ambulances and crews being delayed at a hospital. In addition, treating health and social care as separate, independent, entities results in chronic neglect of the care sector with patients being kept in hospital, to their detriment, while waiting for a safe discharge.

The challenge for politicians in Westminster and Cardiff Bay, is what to do about it? While prevention of ill-health is a long-term strategy, the ageing population, with baked-in chronic disease, is a problem for the here and now. Lack of GPs and access to community services, results in over demand for ambulances, for non-urgent conditions, with patients often presenting at a late stage of illness.

Healthcare, social care and wider society are not separate entities that can be compartmentalised, each has its part to play. More funding is needed in our public sector services, in Wales. For example, we should not be closing schools of nursing at a time of national need, as has just been announced by Cardiff University and hoping that recruitment from overseas can fill the gap. As the general public, we need to act responsibly, not just on personal health but how we use services, thinking twice before calling ambulances, or attending emergency departments for self-limiting and chronic conditions.  

As a society we need to stop deluding ourselves that we can get more services for less investment. The public sector has been cut to the bone, increased technology and innovation and new and improved but expensive drug therapy result in people living longer. This growth in the aged population means the NHS of the future is going to be more expensive than Nye Bevan ever conceived and will need change and investment to meet this challenge.

Professor John Watkins, chair of the BMA Welsh public health medicine committee