Monday, 7 May 2012

We need honesty on the Welsh NHS

There are two stories in the last week on the Welsh NHS that are ringing alarm bells for me.

Firstly, the cabinet paper on a possible public relations campaign with regard the centralisation of Welsh hospital services. Secondly, the conflicting reports between Betsan Powys (and others) and the Welsh Government on Local Health Board (LHB) financial results.

I've blogged before on Labour's plans for NHS reforms. I have to reiterate - I support the creation of "centres of excellence". It makes perfect sense. The primary aim of any reform of the health service should be to improve patient outcomes. The research carried out suggests that it could. All well and good.

It's obvious no district or general hospitals are going to close, and suggesting such is likely a ruse to make these reorganisations sound palatable. What's up in the air is which hospital services are going to be moved around or centralised and where.

These are the sorts of "reorganisation" decisions Hywel Dda LHB in particular (covering Ceredigion, Carmarthenshire and Pembrokeshire) have the unenviable task of sorting out. The Welsh Government will need to defend it on their behalf.

Here's the problem:

You have three hospitals providing the same services. Two hospital lose a service – for arguments sake, minor injuries units. How would you describe what has happened to those two hospitals?

Have they been "downgraded", or has one hospital become a "centre of excellence"?

One is the half-empty description. The other is the half-full description. Ultimately they mean the same thing. Suggesting anything different is an outright lie. It's disappointing to see that the First Minister has got the ball rolling in FMQ's last week:
Leanne Wood (Plaid, South Wales Central) :....Will you tell us, ahead of Thursday's local elections, whether your Government plans to downgrade hospitals or centralise core services?

Carwyn Jones (Lab, Bridgend)....From our point of view, we want to ensure that health services are safe and sustainable. No hospital is under threat. No hospital was ever under threat in Wales....

So some LHB's are actively preparing to reorganise hospital services - in essence taking away from some, keeping them at others - yet "no hospital is under threat"? Yeah, OK.

Some hospitals will be affected by these changes – that's inevitable. Arguing about whether they are "under threat" or becoming a "centre of excellence" is pedantic. At least be upfront and be honest about it. Explain to the public why it's the best option on the table. It should be easy to do so. The Welsh Government shouldn't have to use PR and euphemisms.

The Welsh NHS has become a political football since devolution. It's no longer a public service, but an ideology in itself. It's all Nye Bevan & miners co-ops, black and white images of church-like Victorian institutions with prim blue-uniform nurses and doctors in white coats – all wedded to a greater sense of Welsh collectivism. We're supposed to like the NHS the way it is because Labour in particular have made it such an inherent part of "Welshness" and "something to be proud of" - "our" greatest ever achievement.

Its conservation and protection has been drummed into so many skulls that any reforms – wherever and whenever they happen - are going to be bitterly opposed. These reforms are minor compared to what's happening in England, yet the protests are already starting.

Labour have simply left these reforms far too late, interrupted by the dropping of hospital centralisation as part of the One Wales coalition. Beds have been made, it's time to lie in them.

The second issue is more immediately worrying. Health Minister Lesley Griffiths (Lab, Wrexham) (has quite correctly) instructed LHB's to meet strict financial targets. She's on record in telling the LHB's, via the Assembly's Heath Committee, that they can no longer "expect handouts" due to strained finances.

The wider question remains though – what was the £290million saved in 2010-11 "without harming services" actually spent on in the first place?

Last Wednesday, the Welsh Government hailed the "remarkable achievement" of the Welsh NHS breaking even.

There's one small problem – it was bullshit.

Lesley Griffiths had to dip into next year's funding to the tune of £12.4 million to ensure that three LHB's met the targets she laid down. Like the issue of reorganisation, the news has been sugar-coated along the lines of "drawing down money from contingency funds."

Fair enough. If the LHB's need a bail out - do it. Just remember how silly you're going to look after telling them "not to expect any more handouts". We plebs hate it when politicians don't admit their mistakes. Don't let your pride get in the way of admitting you're wrong, or that a target or deadline has been missed.

The likelihood is that next year, the Welsh NHS will meet their targets - £12.4 million is a drop in the ocean compared to the £6billion+ Health and Social Services budget. The gap has closed dramatically and Lesley Griffiths deserves credit for that. However, these sweet little lies can quickly become big juicy sour ones down the line.

"The cuts"
are inevitably going to be the fall-back position for every single unpopular decision Labour makes – at local and national level - between now and whenever they get back into power in Westminster. It's good cover for centralisation plans, which have been on the cards since at least 2006, resurfacing during the tail end of the Third Assembly, and now on the cusp of finally be put into action.

Like it or not, Labour have both hands on the wheel for this. They can't blame Westminster.

Get this wrong – it'll be a catastrophic bungle if it does go wrong – and it should come back and bite the Welsh Government very hard, very fast, on the backside.

Because Wales loves the NHS, we do.


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