NHS Wales – a fight for the model for the future?

Discussion – Len Arthur

NHS Wales – a fight for the model for the future?

In our newsletter a few weeks ago we made reference to a new Welsh Government consultation on the NHS. The main point of this particular consultation is about reaching a ‘compact’ covering the responsibilities of the WG, NHS and ordinary people and, secondly, how people can play a greater part in managing their own health and improving health services in Wales. As a user – very much - of the NHS in Wales, but a lay person when it comes to health policy and strategy, I found it difficult to pin down in my mind what outcomes of the consultation would mean in practice. This then led me to start to try to get up to speed on debates about the NHS in Wales from a socialist perspective, perhaps leading up to a policy paper or motion to the next Welsh Labour conference. This is the result and I must stress, it is very much a lay and possibly naive view; yet for those reasons might encourage others into the discussion fray!

The Tory privatisation of the English NHS will, we hope, have a minimal impact in Wales due to our devolved control over the provision in Wales. NHS Wales is, however, starting to feel the impact of many of the other Tory policies. Reduction in the total budget allocated to Wales is having an adverse impact, as the Welsh Government attempts to shift money and services around to sustain the existing provision. On 2 October Jane Hutt, Welsh Government minister responsible for finance, announced the draft budget running up to 2015. My estimate is that the NHS Wales budget will be capped in cash terms, resulting in a real terms cut of RPI inflation +1%, to take account of the higher price rise rate for health provision. Already a number of NHS Boards in Wales have faced deficits in the last financial year resulting in a greater spend than the original NHS Wales budget; expect these crises to recur more frequently over the couple of years. One silver lining is that we have escaped the billions wasted on the English privatisation.

Indirectly, the reduction in welfare payments, loss of benefits, real wages and jobs in Wales, will all have an adverse impact on health inequality, resulting in higher demands for acute and chronic NHS services. Local government, despite having marginally a better time in Wales, will be hard-pressed financially and in terms of increased service demands, and will, consequently, have little spare cash to take over provision that the NHS can longer afford. In health, standing still is not an option as, generally, improved clinical diagnostics and therapies result in the need for greater finance. Finally, age; as a baby boomer myself I know that an ageing population will increase demands on the health service.

Whilst the pressures mount, expectations are high on the devolved governments to keep the NHS as a public service, so a model exists to re-establish the UK NHS when the Tories are defeated. As socialists, we expect the Welsh Government not only to sustain NHS provision that is of a high quality and without recourse to privatisation, but to also to improve that service. One of our comrades, Julian Tudor Hart, has written extensively on the importance of the provision of a health service not being a marketable commodity sold for profit. He has demonstrated, through his research, how a market-based approach diverts attention from improving the health of all the population through a comprehensive strategy, moving policy toward one where medical provision that can be sold is separated out and, increasingly, only the rich can afford the best that is on offer. Recently he gave a paper (see under lectures & speeches 24.11.2007) where he argued that what is happening, and can happen in Wales, could provide an even better model of a comprehensive health service. This is an expectation beyond just sustaining what is - trying to keep things ticking over until we defeat the Tories - but taking NHS Wales forward to ensure that all the population enjoys the highest possible health and life expectancy. Can we still do this?

It is clear that this aspiration is expressed in many Welsh Government documents. It is there in the health section of the Programme for Government and the latest outcome report; it is there in the health sections of the draft budget produced on 2 October sections 9 – 9.20. In addition, it seems clear to me that all the key indicators in the latest Programme for Government outcome report and in the latest Medical Officer for Wales report show that Wales is has managed to keep the main threats to health in check and, in some cases, make some important improvements. At the moment, the indicators show no sign of a worsening situation and suggest that the comprehensive approach so far implemented in terms of prevention improved healthy living and improved acute and chronic care, is working. The one indicator that shows a stubbornness to change is the different class life expectation: there is still a class way of death. At least this issue is recognised and prioritised in Welsh Government policy; a very big ‘however’, of course, is that this picture reflects a period of increased public spending.

So there is a circle to square: as socialists, we would insist that the health of the population should be protected comprehensively and in large part this is recognised by the commitments and policies of the Labour Welsh Government, however, Tory cuts and other increased demands threaten to derail these policies. The Welsh Government is hemmed in financially even more than local authorities, so raising alternative revenue and capital finance is difficult, but not impossible if the whole of the public sector in Wales worked together. Even spending all the reserves on health – and this may very well happen – may not solve the problem. An additional answer has to be to look collectively at how our health objectives can be taken forward. The consultation document referred to above avoids these issues and diverts attention to adjustments to structures, which may be needed, but what is required now is a full and open debate where ‘smoke and mirrors’ are set aside.

It is for the Welsh Government to initiate this debate. The important details and alternatives however, will be considered locally and even implemented there. Currently structures exist where this debate and action can be taken forward: community councils, community health councils, unitary authorities, AMs, MPs and centrally the trade unions. They may appear disparate and distant from health but it is possible for Labour members and activists to push for a coordinated response. The ‘Together for Health’ proposals from the five health boards in South Wales provide an opportunity to act on this over the next 12 weeks. Consultation details are available through the local health boards. To what extent do you think we as socialists should be involved? And what should be our main arguments?