As junior surgeons in the Royal Navy, part of our training would involve a Mass Casualty Exercise. They’d run something like: “Expect one hundred casualties in ten minutes time. Your team comprises of you, two first aiders and two others. Your available equipment is a water bottle, a box of bandages and two boxes of paracetamol. Oh, there is a non-functioning lavatory over there, so you could think of removing the door to use as a stretcher”.

The situation is clearly impossible. The most tempting approach was to grab the water bottle and paracetamol, enter the lavatory and bolt the door firmly closed, to re-emerge when everyone else had gone home!

But just giving up and avoiding the challenge isn’t the right thing to do. Try to do the greatest good for the greatest number. Perhaps as importantly, think about it afterwards, debrief and organise your thought processes so when it happens again, you can cope.

Patrick Loxdale
RIGHT FIELD (Cambrian News)

If we look at NHS Governance (organisation) in Wales, it is pretty clear that we are living in a “mass casualty” world; in simple terms the system can’t cope with the demands being put on it. Inevitably, in the Cambrian News we read about our local Health Boards in mid and west Wales, mainly Hywel Dda and Powys. But as of April 9th this year, every local Health Board in Wales (seven in total) was under some level of Oversight and Escalation.

Level 1 means all is functioning as expected. Level 5 is Special Measures. Betsi Cadwaladr is Level 5. Every other Health Board is at Level 4 in at least one key aspect.

Those figures aren’t really news; they were updated by Senedd Research on 1st June. In truth they were well known before the May Senedd Elections. On the face of it, we might assume that the Welsh NHS is in total meltdown.

But of course we will all know of hardworking, dedicated NHS staff who do their utmost, day in and day out to deliver great quality health care. They go that extra mile to do the greatest good for the greatest number. And most of us will at least have friends or relatives who are very grateful for their care. I certainly am.

What we have here is a system breakdown in health care delivery. There is no co-ordinated plan to resolve this, and as things are we get utterly daft decisions like the closure of the stroke units at Bronglais and Withybush.

Fair play, our Plaid Cymru Government inherited this situation. But they were desperate to govern and should have foreseen it. They should have put a lot of time and effort into thinking this through; they could have hit the ground running. But they didn’t and they haven’t.

What’s to be done?

With a minority Government we need broad political consensus. That doesn’t mean wishy washy compromise; what is required here is very strong leadership and a shed load of reality. Solving this demands a genuine whole government approach and no options should be dismissed through dogma. We need what works. All of our MSs share responsibility for that.

Immediately, we must stop the withdrawal of acute services until we have a coherent worked up and acceptable plan. In the medium term we are going to have to think about how we deliver healthcare (do we need the current Health Boards?). And in the long term, how other matters (eg education and infrastructure) impact upon sustainable high quality Welsh health care.

We don’t need to hear Mabon or Rhun wasting their breath blaming others or giving excuses. Kick that lavatory door off its hinges, come out fighting and grip this important issue.