"Very significant heat in the system"

Nearly every day now, I open my inbox to find an email from someone, somewhere pointing to something that's wrong with the NHS in Wales. A number are from ordinary people whose relatives were in great need and didn't get the sort of emergency care their families still expect, and still believe should be possible to deliver.

Today they can all read the letter, seen by BBC Wales and sent by nearly half of the Wales' A&E consultants jointly to the new Health Minister Mark Drakeford.

They'll see that these consultants share their concerns. They'll see they've taken a very significant step in coming together to warn the Welsh Government - eloquently and publicly - that "emergency departments are at the point of meltdown" and that patients are being put at risk.

On Monday, before the letter had hit his desk, we asked Mr Drakeford why he thought there was such unprecedented pressure on emergency care in Welsh hospitals. Why did it appear that the pressure was getting worse? What could be done before the warnings, already loud, got even louder? I've just listened back to the interview and this was his answer:

"There are a number of different reasons - partly because we still don't have clear enough messages out there about how to access health services outside main hours, the whole issue of the ambulance service which is currently under review is part of that mix. One of the things I see as a priority for me over the next 12 months is to tackle the whole issue of what they call 'unscheduled care' and I want a Wales wide approach to this ... so that people get a common set of messages, so that they get a better understanding - a better understanding than we've been able to get so far - of the best way you can get the care you need when ordinary working day services aren't available to you. Taking it in the round, that is the way to try and take some of that very significant heat out of the system".

Very significant heat. Meltdown.

So what's the solution?

The health minister says he wants a new "national approach" to emergency care - but this seems to be principally on the demand side - making sure people up and down the country know where to go for their care.

On the supply side, those who work on the front line say the way it's currently organised isn't really working for anyone. Looking for solutions, they divide treatment for patients into three main categories.

First of all, the very sick patients needing immediate and extensive care, people with severe strokes, heart attacks, major trauma and so on. The way things work at present, they're taken to their local District General Hospital accident and emergency department, where they're sometimes met at the door by a junior doctor with little experience of their condition. This and staffing, or resources pressures can lead to delays with triage in a situation where every second counts.

The way to improve care for this group, it's said, is to move to a system of fewer but much more specialist emergency departments.

Yes, they may be further away than the current network of A+E departments, but the difference would be that you would be met at the door by a senior consultant who would know exactly what's best for you straight away. It wouldn't be at the end of your metaphorical street but in reality your chances of survival are far higher if you're seen by a specialist straight away. The proposed but long-delayed Specialist and Critical Care Centre for Gwent would be a model for the new system, but the price tag has so far been a major impediment to its introduction.

This is a illustration of why a new specialist system wouldn't save any money, of course, but it could have a big impact on patient outcomes.

The second group is people attending A+E with relatively much more minor injuries, bumps, cuts and scrapes. This is where it's possible for big financial savings to be made, by treating them more quickly without resources being tied up with critical cases, alongside the Minister's new push on trying to cut down on the number of unnecessary attendances to hospital. Of course, this would see many of what are currently fully fledged A+E departments look much more like Minor Injuries Units - another tough sell to the public.

Thirdly, there's the long standing issue of older people stuck in hospital because there isn't a suitable onwards care solution available for them. This is where at least some of the current pressures are coming from, with people spending 24-36 hours - and in some cases up to three days - stuck in emergency wards because they can't be transferred elsewhere in a hospital. The problem of bed blocking has been around for so long that it's astonishing that solution still hasn't been found - but it remains.

Why does it still remain?

As long as the NHS and local authorities social care budgets remain separate and guarded jealously by their respective managers then it seems hopeless to expect things to changed. Again, pooled budgets between the two have been under discussion for many years but have yet to come to any large-scale fruition.

Add to that a fall of nearly a fifth in the number of NHS beds in Wales over the past decade and the pressures illustrated today should come as little surprise. But the hugely controversial reorganisation in North Wales didn't even scratch the surface of these changes for their area. Hywel Dda Local Health Board did - and cue vociferous protests outside Prince Philip Hospital in Llanelli, as well as elsewhere.

The South Wales boards - Aneurin Bevan, Cardiff and Vale, Cwm Taf and Abertawe Bro Morgannwg are preparing to lay out their plans and I'm preparing to read a full inbox, when I'm back after a break over Easter.

Pasg hapus i chi bois.