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David Sissling, chief executive of the Welsh NHS, has said the country's integrated health system has allowed rapid improvements in its performance on emergency admissions, and that this would not have been possible in England's more fragmented and market-orientated health service.
He told a session at the NHS Confederation conference in Manchester that the NHS in Wales has cut emergency admissions for chronic obstructive pulmonary disease and diabetes by 16.5% and 14.6% respectively in just one year, with emergency readmissions falling even faster, although from relatively high starting points.
"We don't work in a market. We work much more on an integrated basis," Sissling said, with seven health boards providing both primary and secondary healthcare to their areas. "There is no 'them'."
"We have a Labour administration in Wales that has made a very firm decision to move away from the market. That's partly a political stance, partly what's right for Wales," he added. Welsh health boards receive income based on the number of people in their areas, with adjustments based on local health needs.
Sissling said that integration means that primary and secondary healthcare staff can co-operate for the good of patients without worrying about the financial effect on their organisations. In reducing emergency admissions, the Welsh NHS brought together GPs and hospital specialists for discussions on patients' pathways through the healthcare system, and this led to the establishment of community teams to manage patients before and after hospital. "Change can happen in smart, real time," he said.
Sissling said the improvements took place at the same time as a severe financial squeeze on the Welsh NHS, which last year saw no growth in its budget in cash terms, meaning it shrank in real terms. This provided another motivation to cut emergency admissions, which are expensive as well being generally worse for patients. The Welsh NHS also reduced Clostridium difficile cases by a third in the last year, although Sissling said this was down to adopting good practice rather than anything to do with health service structures.
He added that the NHS in Wales shares problems with other parts of the UK, such as too much hospital capacity. A consultation will take place on this, which will be "turbulent, difficult but necessary," Sissling said.
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