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!