00:00I now move to the short debate, and I call on James Evans to speak to the topic that
00:06he has chosen.
00:07James.
00:08Thank you, Presiding Officer.
00:09I would like to give a minute of my time to Russell George, Sam Rowlands, Gareth Davies
00:14and the one and only Janet Finch-Saunders.
00:18The future of healthcare in rural Wales is under serious strain.
00:22In Brecon and Radnorshire, we face a unique set of challenges due to our sparsely populated
00:27areas, which has limited access to hospitals and emergency services.
00:33Most residents are forced to travel outside the county to receive essential care.
00:37This issue is especially concerning given our ageing population in Powys, where nearly
00:4228% of the population are aged 65 or older, much higher than the national average.
00:49This figure is projected to skyrocket with over-65s reaching 47,000 by 2036.
00:58Despite these increasing needs, Powys Teaching and Health Board struggles under a £23 million
01:03budget deficit, a clear indication of financial mismanagement.
01:09While some positive steps have been made, such as advancements in stroke rehabilitation
01:14and mobile dental unitsóall these are to be welcomedóthey are consistently undermined
01:19by significant cuts to our essential services, which are always on the front line.
01:26Most concerning are the cuts to MIU opening hours across rural Wales and the downgrading
01:32of Craig Ward in Brecon, which cared for dementia patients.
01:36Knighton Hospital in the north of my constituency has been reduced to a small respite unit,
01:41further diminishing the scope of the care we can provide locally within our cottage
01:45hospitals in rural Wales.
01:48The downgrading of these services aren't limited to Powys alone.
01:52Recently, a Nair and Bevan health board announced the closure and downgrading of wards, meaning
01:57a loss of nearly 15 beds at a minimum.
02:01Our district general hospitals in Merthyr, Hereford, which is across the border, Swansea
02:07and the Grange, are frequently at capacity and on red alerts, and maternity services
02:13in Bronglais can't accept any more patients.
02:18These are not isolated cases, but signs of a systemóour NHS here in Walesówhich is
02:24buckling under pressure.
02:26I do applaud colleagues from all across the political spectrum in this Chamber who have
02:30spoken out cuts to the NHS in their own communities, as we're all facing the same challenges right
02:36the way across Wales.
02:39For non-acute care, the situation is even more fragmented.
02:44It's unacceptable that elderly residents in Abercrave must travel as far as Telford for
02:50eye appointments because of service-level agreements that rural health boards strike
02:55across the country.
02:57Even though a closer hospital in Swansea could handle that treatment, it simply isn't good
03:03enough.
03:04Similarly, patients from rural Wales find themselves driving to Shrewsbury for orthodontic
03:09care for their children, despite these services being available much closer within Wales.
03:16These examples show the breakdown in co-ordination between health boards, leaving patients stranded
03:21in a web of bureaucracy and needless travel, and more often than not, as an MS and other
03:26MSs who represent rural Wales, we are contacted to pick up the pieces.
03:32Our health boards may be under budgetary pressures, but there is no excuse for mismanagement.
03:39That disproportionately impacts our frontline services.
03:44Efficiencies could be found in the NHS by streamlining management, improving organisation
03:51and rethinking our approach to healthcare delivery.
03:56Time and time again, we hear the Health Secretary that they won't intervene in local decisions,
04:02yet this isn't just a local decision, this is a national problem.
04:07We still lack across Wales a unified IT system across health boards, and waiting lists in
04:13Wales are out of control.
04:16We need strong oversight from the Minister, and it's time to shake up the system to root
04:22out waste and prioritise the health of our people.
04:26I know the previous Health Secretary did some work into looking into the organisation and
04:31accountability of health boards across Wales, and I'd be very interested to hear from the
04:35Cabinet Secretary a little bit about that and how he can actually hold health boards
04:40more to account.
04:42What we do see, though, is top-level management positions across health boardsóthey keep
04:47getting advertised, yet I hear countless stories, I'm sure as others do, of roles that one person
04:53used to handle now being expanded into multiple positions with no increases in efficiency.
04:59This must change.
05:00The bureaucracy grows and grows as front-line services are cut.
05:07The critical role of GP practices in rural communities cannot be overstated.
05:11We had a good debate in here earlier on the future of our GP practices.
05:16They are our front line.
05:18They are the stop-the-gap between critical services and community services, but many
05:24of them feel they're consistently fighting against health boards just to provide basic
05:30care because they cannot get contracts arranged with health boards.
05:35Their innovative ideas and solutions to improve service areas are often ignored.
05:39They're presented to health boards across rural Wales, and the health boards don't want
05:44to listen to them.
05:45I'd be interested to hear as well from the Minister how actually our GPs can feed more
05:50into the process and directly correspond with the Minister to make sure that their decisions
05:56and their ideas are being heard by government.
06:00If we are serious about rural healthcare, we do need to empower our GPs and give them
06:05the tools to manage their practices efficiently.
06:10Dementia care is yet another issue that requires immediate attention.
06:16In rural Powys, only 40% of those living with dementia have received a formal diagnosis.
06:23That's shocking, meaning more than half are without essential support and treatment, and
06:29without that diagnosis, they can't get the changes and adaptations they need to stay
06:34in their homes for longer.
06:37With an ageing population, this lack of access to diagnostic resource is alarming.
06:43We must do better for those individuals and ensure that every person, regardless of where
06:48they live, has access to timely, quality healthcare.
06:52The people of rural Wales deserve better.
06:56Our communities are being neglected by a system that has lost sight of what truly matters
07:01and more focuses on urban areas.
07:04We need a healthcare system that serves its people and not one that forces elderly residents
07:10into arduous journeys and ignores the hard work of our GPs and other health professionals.
07:17One thing we do need to look at is the structure of our NHS across Wales.
07:24The NHS is not a sacred cow.
07:28It should not be immune from change, and time and time again we see governments not willing
07:34to grasp it by the nettle and actually deliver the changes needed, because governments worry
07:41about the political backlash of changing the NHS, of driving efficiency and making it serve
07:48the people of rural Wales and the whole of Wales better.
07:52I implore the Welsh Government to forget the ballot box.
07:56Think about the people that the changes could actually make to get them seen in appointments,
08:01get operations done and make sure the system works better.
08:06The future of rural healthcare in Wales depends on action and accountability and a commitment
08:12to making real changes to the people who need it the most.
08:16It's time to prioritise frontline services, invest in our GPs, demand the joined-up approach
08:22that will deliver the healthcare our communities deserve and deliver that NHS that we all need
08:27for the future.
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