For all doctors and most parties contesting the Senedd elections next week, one thing is clear: the NHS in Wales is stretched to breaking point.

As BMA council chair Iona Collins notes in the foreword to the BMA Cymru Wales election manifesto, Health in our hands, ‘the visible symptoms – record waiting lists, corridors becoming default wards and GP surgeries closing their doors – point to a system under unsustainable strain’.

Yet, the decline of the NHS in Wales is not inevitable, BMA Cymru Wales insists.

Its prescription for change is summed up in five principal asks: ‘rescuing general practice from the brink; truly valuing and retaining our doctors; making patient safety non-negotiable; prioritising a prevention-led approach; and creating clear pathways for doctors to train and stay in Wales’.

In the second of our pre-election reports, following our feature on primary care, three doctors in secondary care share their frustrations and hopes.

Another day at Glan Clwyd Hospital in North Wales, another patient is fading fast in a corridor.

An older man with acute abdominal pain has been hooked up to a drip. But he is in a chair, in a tight passageway brimful of other patients, blasted by cold air each time the double doors nearby swing open.

Sixteen hours in and the man’s mortality risk has doubled by the time consultant anaesthetist Manish Adke sees him. The patient needs a laparotomy: he ends up in intensive care afterwards, with lines in place.

‘It breaks my heart,’ says Dr Adke. ‘I find it morally challenging that I’m unable to provide the best care for patients. This is harmful, inappropriate and disrespecting human values.’

So many of the problems facing secondary care in North Wales have conspired to consign this patient to ‘corridor care’ in Rhyl: staff shortages, lack of beds, a health board in special measures for the best part of a decade. Betsi Cadwaladr board covers almost a third of Wales’s land mass and about a fifth of its population.

For Dr Adke, things deteriorated sharply and corridor care was ‘normalised’ after COVID. The closure of community hospitals in North Wales from 2013 onwards has made matters worse. ‘The beds just disappeared and they have never been replaced.’ Nearly 89,000 patients were treated in corridors in North Wales between 2022 and 2025, according to data obtained by S4C.

North Wales now has about 1,500 beds in three district general hospitals for a population of about 700,000, which Dr Adke says is about 15 per cent short. And the population is becoming older, more frail, with more chronic illness.

The Welsh government’s response this spring to joint lobbying by the BMA and RCN (Royal College of Nursing) for an end to corridor care was to instruct health boards to shift patients from public corridors into ward corridors.

‘So nurses and doctors are dealing with excess patients without any additional resources or staff,’ says Dr Adke, who chairs the BMA Welsh consultants committee. ‘And these are sicker patients coming from the emergency department, not routine elective patients.’

Instead of investment in the NHS workforce and capacity-building in Betsi Cadwaladr, care is being outsourced to private providers, such as cataract and orthopaedic joint replacement surgery in England.

Furthermore, first outpatient appointments for a number of specialties were insourced from November to March, in a multi-million pound deal.

Dr Adke had a few such appointments himself as a patient. ‘They didn’t have access to investigations or online notes, couldn’t order any investigations or prescribe any medication. I received a letter after three weeks to say Dr Adke wants to continue to be seen by the consultant. It’s a waste of money.’

Dr Adke, with BMA and RCN colleagues, will continue campaigning in the next Parliament, calling for data on corridor care to be collected, a pause in reductions in bed capacity, investment in community-based care, and prioritisation of prevention and early intervention.

‘If you want to do one thing to improve the Welsh NHS and solve the majority of problems we are facing, invest in bed capacity,’ says Dr Adke. ‘But, because of the special measures situation, investment has gone into outsourcing, insourcing and management restructuring rather than [into] those like doctors and nurses who deliver actual services.’

For a small nation, Wales performs well in many aspects of its cancer care.

Advances in genetic testing of cancers, new treatments and clinical trials, good rapport with patients, great colleagues – these are all the things that keep Sam Cox going.

Yet, a sluggish system means her patients, who have lung cancer, are often waiting too long for treatment. Because they tend to present late, delays can mean they deteriorate.

The 62-day referral-to-treatment target for cancer patients in Wales is being met in only 58 per cent of cases, against a target of 75 per cent.

Improvements in cancer diagnosis and treatments are not yet translating into better patient outcomes, due to increased demand and lack of capacity in the system.

Five-year survival rates for lung cancer are still only 15 per cent: it remains the leading cause of cancer deaths in Wales and the UK, with many patients diagnosed with advanced disease.

Yet, despite a 2022 recommendation from the UK National Screening Committee to introduce lung cancer screening, the Welsh government opted to start with a limited pilot project. A wider roll-out across Wales is still awaited – a delay that Dr Cox finds frustrating.

‘People working on the shop floor, doing the job day in day out, often know what needs to be done to improve cancer outcomes,’ she says. ‘We need timely access and funding to support innovations such as screening.’

Meanwhile, Dr Cox’s job can feel relentless: the 20-minute slot per patient in a full clinic is at times hopelessly rushed – especially if there’s bad news to break – and clinics are often overbooked.

‘Patients have to be reviewed in clinic before each cycle of treatment but if the clinic is full, the only option is to overbook otherwise the treatment can’t go ahead.

‘This means we are working under constant pressure, and I do worry about dropping the ball and making a mistake.

‘So it’s the constant moral burden of wanting to provide quality care but being restricted by a system which lacks capacity to do the job properly, and you feel responsible for that and have to absorb it.’

Workforce planning, including a lack of specialty training posts, is a real concern for Dr Cox. ‘We’re not recruiting enough people to deal with the rise in cancer incidence as people are living longer and we’re diagnosing more cases, let alone accounting for attrition rates from the working environment.’

Data from the Royal College of Radiologists suggests a 38 per cent shortfall in radiologists and 23 per cent in clinical oncologists in Wales by 2029. In North Wales, the shortfall in oncologists is predicted to be 79 per cent. In 2024, the radiology and clinical oncology workforces in Wales both grew by just one per cent.

So Dr Cox is hopeful that the forthcoming elections may offer an opportunity for change. ‘We desperately need a longer-term, fully funded cancer strategy that includes a commitment to developing the workforce in Wales,’ she says, ‘so that we can realise the potential of advances in diagnosis and treatment, and improve outcomes for our patients.’

It’s become something of a cliché – that healthcare should be delivered by the right people in the right places – but, for Iona Collins, it sums up all that’s wrong with the NHS in Wales.

Currently, she believes, for lack of other options, many people are ending up in hospital inappropriately, ‘suffering avoidable harm’ in cramped and often distressing conditions, including corridors.

They would be much better served by care closer to home, with their family doctor and ‘wrap-around care in the community’, she says.

Restoring the NHS in Wales requires a radical rethink, ‘looking upstream’ towards prevention and strengthening general practice through urgent investment and a targeted workforce strategy to improve GP recruitment and retention.

‘It is more pragmatic, more humane, as well as being more cost effective, to nip problems in the bud, and keep people as independent as possible and in their own homes,’ she says.

Centralised healthcare – epitomised in the closure of many community hospitals – simply does not work in a nation with a population density roughly a third of England’s, and one with an older, sicker population, says Dr Collins.

With appropriate investment, general practice could deliver far more in local communities, from performing minor surgery to managing chronic disease care outside hospitals. ‘The question is whether the government has the money to implement any of these changes.’

Without this left shift, says the BMA Cymru Wales manifesto, ‘even more surgeries will disappear, while patients face even longer waits and pressures on hospitals intensify’.

Dr Collins remains optimistic that change will come, though, because no change is not an option. ‘It’s inconceivable that we can allow the health of the nation to continue deteriorating as it is at the moment,’ she says.

• We also asked doctors in primary care in Wales for their priorities ahead of the election