Judith Paget, the head of the NHS in Wales, has acknowledged the need for "a rapid increase in staff" as well as quick change.
She also wouldn't rule out stopping medical assistance until patients changed their lifestyles to enhance their health.
The chief executive stated that there is a plan to increase staff numbers "over time" and that recent strike action had brought attention to the need to care for current employees.
As the service celebrated its 75th anniversary, Ms. Paget spoke.
Regarding the subject of withholding care due to lifestyle choices, she stated: "If there is good evidence to consider what that looks like, I think that is a possibility.
"We are aware that obesity impairs a person's capacity to recover quickly from surgery and to respond well to it. In order to help people lose weight before surgery, that is what we want to do. ".
She did make it clear, however, that she "would struggle with the concept of refusing people treatment based on some of their lifestyle choices.".
Ms. Paget acknowledged that the service must change in response to the rising demand for its services, which has increased by 13% just in the past year. This is in contrast to Stats Wales' estimate of 5,000 open positions, which organization acknowledged may be an underestimate.
The pandemic backlog had been cleared more slowly than she had preferred, but she insisted that "we are getting there.".
In Wales, there are currently 582,000 patients on the treatment waiting list, which is just over 743,300, and the Welsh government's targets to cut down on wait times have not been reached.
She said, "I think we need to change what we do.". "How we focus on keeping people well is one of the things that we really need to focus on: preventing illness; supporting our patients to make healthy lifestyle decisions. ".
She referred to "the huge challenges ahead of us" brought on by diabetes and obesity as well as the necessity for people to maintain their health.
However, she noted, there have been changes in the way services are provided.
Controversial plans to centralize a few specialized services in south Wales were abandoned ten years ago.
Today, a different model is developing, but waiting times have changed the conversation thanks to the creation of a regional diagnostic hub and centers that specialize in orthopaedics and eye surgery and serve patients from multiple health boards.
"I believe it is crucial to have these discussions with the communities who may be impacted by any change, but we must also concentrate our resources on providing patients with the best possible health outcomes.
"At the moment, technology and research are pushing us in different directions.
There is a lot more we can do outside of the hospital, in people's homes, in local community settings, in neighborhood GP and doctor's offices, and in other primary care facilities.
"So, something is pushing us in this direction, toward decentralization. The need to further centralize our extremely specialized services is obviously another pull we must consider.
"We must give people the ability to access diagnostics very quickly, and the best and most efficient way to do that is in larger centers where we centralize everything together. ".
Is the 75th anniversary of the NHS a time to celebrate or reflect, given the low staff morale and patients' frustration with access to care?
She said, "I believe we ought to be honoring the NHS staff.".
They have experienced a great deal over the past few years. They are still facing many difficulties.
"I believe that the ongoing criticism they experience has an impact on their morale as well.
So yes, I believe it is time to look back and reflect. However, I believe there is a greater need to acknowledge the work that NHS employees do on a daily basis to support us.