Thursday, April 03, 2008

Don't be sick in Wales.

Long post this - but my family's healthcare matters to me. The National Assembly for Wales has now been in existence for 9 years. I wonder who readers assess as the worst Minister during that period. And no favouring anyone who is rather a nice person. I mean who has achieved the least and cocked-up the most. Now, I'll turn to the political leadership of the NHS in Wales over the last 9 years.

In 1999, Alun Michael appointed Ms Jane Hutt to be his Minister (then known as Secretary) for Health and Social Services. She immediately set out to reorganise the Wales NHS, and decided to focus on health prevention rather that getting people treated. She may well have said that her aim was to "improve patients care and the patient experience, ending competition in favour of co-operation."
Oh how they cheered on the Labour benches, and on the Lib Dem ones too, when the Lib Lab Pact was agreed in 2000. Throughout this period, Ms Hutt was under the heavy influence of a strong hallucinatory drug called coterminosity. She created a pyramid of bureaucracy, founded on 22 Local Health Boards, coterminous with local councils. When our man, the visionary David Melding warned of impending doom, she accused him of insulting this thing called coterminosity.

Anyway, Ms Hutt was moved suddenly one day, in fact it was about a day before a damning report was published about the state of the NHS. Her successor, Mr Brian Gibbons, was forced to shift his focus back onto getting patients treated, and reducing the horrific differences in the time that patients from Wales and England had to wait. His stint as Minister was truly a poisoned chalice. And then yesterday, the current Minister, Edwina Hart blew Ms Hutts coterminous NHS structure into oblivion. Very soon there will be nothing left to remind us of the time our NHS was entrusted into the care of Ms Hutt.

I've been trying to get my head around Edwina Hart's 'Proposals for Changing the Structure of the NHS in Wales', which were announced yesterday. She tells us that her aim is to "improve patient care and the patient experience, ending competition in favour of co-operation". Now, where have I heard that before?

Now this is a complex issue. The NHS is currently divided into 'purchasers' of services (22 Local Health Boards) and 'providers' of services ( 10 NHS Trusts). Mrs Hart proposes to end the 'purchaser' role of LHBs and create an All Wales Strategic Authority to do the job instead - so far so good. Personally, I hope that this body is as independent of the Assembly Government as possible - but don't hold your breath with this lot. But she is not abolishing the LHBs. She wants to reduce them from 22 to 8 (none of this coterminosity claptrap from Edwina) and give them an entirely different job to do - become the 'provider' of GP and Community Health services. Now I'm not sure about this. I will need to consult Mr Melding again. The NHS Trusts carry on as before, with a chunk of their responsibilities hived off to the LHBs. So it looks as if the end result will be less bodies, but an extra tier. We have three months to think about it and comment.

Mrs Hart is claiming that this ends the internal market, something else I'm trying to get my head around. Seems to me that there is still a 'purchaser'/ 'provider' split - its just that it is in a different place. And surely I cannot believe that the All Wales Strategic Authority is not going to shop around for the best price. Please don't tell me its just going to pay what the Trusts think it should be. Perhaps we'll all just have to pretend there is no referenceto price at all - just so that her Plaid Cymru coalition partners can go around boasting that they have in some way cleansed the NHS of the dirty word, 'competition'. - just so they can feel better.
Oh and by the way, Ms Hutt is now responsible for education!


Left Field said...

I do like the snappy name for my new health board:

Abertawe Bro Morgannwg University NHS Trust.

Their compliments slip must as long as a roll of wallpaper.

Anonymous said...

Anwyl Glyn, can you start at the begining, but this time speak slowly, are you trying to tell us that we have been walking around in circles but worse than that we've been walking backwards ?

Anonymous said...

worse still is that Edwina and the rest of the lefty lovies in Cardiff Bay think this is a step forward, progress even.

Were not asking them to land rockets on the moon or split the atom for goodness sake, just provide a Health Service for a population of 3 million in the 21st century it shouldn't be beyond our AM's and MP's capabilities surely.

Glyn Davies said...

anon - Since 1999 there has been huge investment in the NHS, but nothing like the benefit there should have been. In terms of NHS structure, the Assembly Government has been struggling to operate the ridiculously complex arrangements that Jane Hutt put in place. Edwina Hart wants to dismantle the whole thing - very sensibly in my view. Essentially she wants to create one 'purchaser' of services (the Government, in the form of an All Wales Strategic Health Authority) and 18 'providers' (NHS Trusts and Local Health Boards). There will be a debate about precisely how these work in detail over the next 3 months. While its a massive climbdown by the Government, it seems to me to a lot better structure than we have at present. Plenty of scope for more cock-ups of course.

Doctor Kildare said...

What is really interesting is that Edwina once again has gone to ground and refused to be interviewed. Major announcement and no minister communicating with the electorate except I suppose by telepathy. Sums up the Assembly really.

Anonymous said...

Glyn, we can agree that's its better than before because it more of less what we had before the 22 Local Health Boards were created, my point is that that providing a health service for Wales shouldn't be that difficult and this announcement is not going to give us a 21st century NHS, it is as the Western Mail said yesterday tinkering round the edges not addressing the real issues.

i also agree with Dr Kildare on Edwina's non appearance, but its also the culture that the Labour Party has created in Wales when they don't even feel the need to go to the National Assembly or the media via a press conference to make these type of major announcements of policy so that they can be scrutinised properly.

Dr. Christopher Wood said...

Well, don't be sick in the UK ...

Gordon Brown's vision for a 'healthy' Britain:

"DIY dentist grandmother pulls out own teeth" ...

Glyn Davies said...

Doctor Kildare and anon - This is the way Edwina Hart operates - and it would have been difficult for her to answer questions because most of them would have been about the inadaquacies of her colleague, Jane Hutt. So we just had silence. Its not just the Assembly though. How often have we heard Newsnight tell us that there was no-one from the Government available to discuss an important issue.

Rhodri Morgan has a contempt for the Assembly. Can you remember his announcement that several public bodies, including the WDA and WTB were to be incorporated into his Government at the last meeting before summer recess, without a word of discussion with anyone beforehand, A Government which will do that will do anything.

I think the proposed structure will be better than the existing, the creation of which has probably been the Assembly Governmnet's greatest mistake - even if it is a return to what went before, roughly speaking.

Left Field said...

Dr Chris,

I remember Emo Phillips saying that in the US, his father needed a heart bypass and they had to sell his house. If they had had the NHS, he would have inherited it!

Dr. Christopher Wood said...

Left Field> I have to agree, the health system in the USA sucks BIG TIME. Nearly 50 million people have no health coverage; my mother is one of them. Over 70 years old, and I can't get health coverage for her. We live on a wing and a prayer. While individuals might beat the odds, some 48 million Americans won't. The USA spends a significant chunk of GDP on health care yet so many go without. When I first moved to Chicago I was shocked at how working poor I saw with leg problems - ankles that had been broken but not treated properly.

Many folks have the impression that Americans have it better - yes some do, but many DON'T. I am puzzled why America gives so much away when much of its own population is in dire straits.

If you go to St. Louis - the east side is - well, shacks. Large spaces between houses because I guess no one can afford to replace the ones that have gone to rack and ruin and so they get bulldozed. First time I saw it (from a highway), I was bowled over.

Washington DC has a terrible homeless problem - this in the capital of the USA. Homeless desperate people within sight of the Capitol building. Obvious power and privilege next to desperation, homelessness, etc.

When my mother's best friends came to visit last October I arranged for them to stay in a downtown hotel near the Capitol building (Congress). They told me they saw young men across the street from the hotel sheltering and sleeping in a recess and in the morning they were gone - it seemed to be a routine for them.

See, e.g., '400 of 'Most Vulnerable' Homeless to Get Apartments" (in Washington, DC or as they sometimes say here, "in the District"; short for: "in the District of Columbia".

Anonymous said...

Dr Chris,
piss off!!!

Dr. Christopher Wood said...

An> your rebuttal was ‘everything we have to come to expect from years of (government) training’, a very precise, on all fours, and on point rebuttal. “Now, if you can look into this light …”

Source of raw material: MIB, the movie.

alanindyfed said...

Picking up on your final point - education - it is declining standards which have pushed up the pass rate, so that now far more students achieve their qualifications, and it is all designed to make the government look good, while many leave school and can hardly spell let alone write a lucid essay.
From an ex-Grammar School-boy!

Valleys Mam said...

Next policy = reorganise the 22 LAs back to County Councils, theres a good one.
One major point that concerns me is that EH doesnt look as if she plans to get rid of the 22 CEOs, they actually have been the biggest expense.But this is another process, when to we get solutions to providing healthcare

Anonymous said...

see also

Glyn Davies said...

alan - I'm always a bit reluctant to take the same line as you on this. But I agree that standards must have fallen for the pass rate to be much increased. I think most observers without a direct interest agree. In some parts of the UK, I'm told that it has become very difficuilt to teach because of the behaviour of some disaffected pupils - which is a reflection on society rather than education.

Valleys Mam - More likely a gradual merger of local authorities on the basis of the Spacial Plan perhaps. I don't think that the relationship between the National Assembly and Local Government has settled down yet. If the Assembly Government takes 'strategic' resposibilities upon itself, there is no reason why the 22 LAs shouldn't continue, but it will be more as deliverers of Assembly policy rather than a real 'leadership' role in their counties. I agree that there is change to come in this area.

Activist said...


If you are going to be an MP you must shape up on research. There are no 'prices' in Wales, as there is no tariff and in England the Tariff is the same everywhere. So conclusion - there is no shopping around based on price in Wales or England.

Edwina is simply taking pointless transactions out of the system and the illusion that small and junior LHB teams can in some way hold trusts to account. A big brassy CEO for Wales (ie not the present one) and a tough national board will however. One board to plan and finance secondary care in a population of 3m is more than enough take it from me.

The real issue is will consultation support a secondary community split or will the response be move to the Scottish system of a single integrated Health Board for each region.

Either way from a Tory perspective markets and the private sector are history in Wales.