Accountability vacuum causing problems for Welsh Labour?

With Hywel Dda Local Health Board formally adopting
its hospital reorganisations today, is this the
start of an uncomfortable period for Welsh Labour AMs?
(Pic : BBC Wales)

I only saw these last week, but there are two videos (here and here) of Sandy Mewies AM (Lab, Delyn) talking with protesters outside a meeting in Connah's Quay back in September. The protesters were campaigning to save Flint Community Hospital, which has been outlined for closure by Betsi Cadwaladr University Local Health Board.

Although this was a while ago, I think this exemplifies a big problem with regard public service delivery. Sandy makes repeated claims, or implied, that it's "not to do with me" – a classic politician's line if ever there was one.

Right, OK, she doesn't come across too well in the videos. However, in this case, she's technically right and it's going to cause the Welsh Government and Labour AMs headaches in the coming years.

Who runs the Welsh NHS?

Local Health Boards (LHBs) actually run and administer NHS services in Wales. The LHBs are the ones overseeing hospital reorganisations and consultations on reorganisations. These are run by appointed officers and managers, but those higher up are practically anonymous.

Community Health Councils (CHCs) are supposed to represent the views of service users and the general public. Local councillors are represented on those boards – in a similar way to police and fire services.

The Welsh Government, and by extension Labour AMs - like it or not - are politically accountable for these reorganisations. But in practice they have very little say in what's being done. They can only scrutinise really, and that's – primarily - being led in the Assembly by opposition AMs.

Labour AMs have been quiet with one or two exceptions. Backbench Labour AMs seem unwilling to speak either for or against the LHB decisions, and that was one point raised by the Flint protesters. I'd draw your attention back to what's been said about Assembly plenary sessions.

I'm convinced that's just one reason reason why some public services in Wales are poorly run, because it's always someone else (Councillors, AMs, MPs) carrying the can, even if they had nothing to do with the decision-making.

So, the decision-making ability rests in one place, the accountability rests with the politicians. They should be joined together. I think that's what most people would call "a functioning democracy".

Say what you like about PCCs, but at least you can't say that of the police anymore.

What's going wrong with hospital reorganisations?

I've said several times that the changes make sense - primarily because of shortages of specialist medical staff. I should be explaining why the changes are needed. However, whenever I go to do so, some other bungle appears – whether that's by ministers, LHBs or someone else. I go back to banging my head against the desk, hoping to wake up one morning and find I'm only human left alive, or that Wales is sinking into the Irish Sea, so we can put all this madness of thinking we have a functioning country to rest.

It's been rushed – Perhaps that's with one eye on NHS budgets, which are under immediate strain, but many LHBs are using 12-week consultations (the bare minimum) for the public to judge changes that will last decades. In an ideal world, this would've been phased in over several years. Even if it is going to be, that's not the impression given.

People still don't understand what's happening – This is supposed to be the point of the consultations, and some LHBs have gone some way in explaining the changes to the public. However, some consultations have been poorly attended and if you mention "hospital changes" to anyone in the street, they'll probably assume that means "closure". In fairness, sometimes that is the case – especially smaller community hospitals like Flint. Today it was announced that a community hospital near Llanelli will shut.

"No hospital is under threat, and no hospital was ever under threat in Wales" - Carwyn Jones, First Minister's Questions, May 1st 2012.

People assume the worst about NHS changes because that's what Labour have been saying to them for decades, putting it constantly in a position of danger unless Labour are running it. Heh. It has to be said that some opposition AMs are making the job harder too, but that's....their job.

Bad news follows more bad news – Again, this isn't helping things. Stories about people being treated in ambulances, missed targets, negligence, poor standards of care, failures to recruit specialist staff and sexed-up documents. Today there was issues surrounding Hywel Dda LHB's handling of reorganisation. Yesterday, ITV Wales revealed Carwyn Jones himself redacted parts of a report into the death of Robbie Powell – which is pretty damned serious by itself.

So, the climate isn't ripe for dramatic, fundamental changes to hospital services in Wales at the moment.

Us - Now, we the public rarely help ourselves. I think there's an expectation that to get "proper care" you need to go to a "proper hospital". We rarely hear about advances in things like emergency medicine or home care, which might reduce the need for hospital visits. We also expect NHS staff to perform miracles. I wish more people would pay attention to Welsh Government advice on things like reasons to call 999 or go to A&E. You can find out more information here.

I don't usually disclose what searches lead here, but one that sticks in my mind was "emergency arse doctor rectal surgery port talbot". I don't want to know.

Labour's problem

I feel sympathy for Sandy Mewies' situation in the videos. I don't like to see that happen to an AM (or politician in general), as she's only (sort of) trying to do her job within the confines of the job description. She's been placed in an awkward position.

The decision-making process seems complicated. Basing this partially off Community Health Councils recent calls for "stronger political leadership", here's how I understand it:

1. Local Health Boards run and administer NHS services and propose reorganisations.
2. Community Health Councils negotiate the changes with the LHBs "on behalf of the public".
3. If there's a disagreement, and only then, it gets referred to the Health Minister (Lesley Griffiths).

There seems to be very little direct role in reorganisations for AMs other than to ask questions in the Senedd, or organise protests and petitions.You can understand why an inability to actually do something about it is going to look like inaction to the public - Labour inaction in most cases - if they're not willing to speak out on government policy one way or another on behalf of constituents.

Ideally, the LHBs and CHCs would be democratically accountable for these decisions in some way shape or form – perhaps answering directly to the Assembly's Health Committee. That's something Elin Jones AM (Plaid, Ceredigion) suggested last year, and several times before that, with regard finances. I think it'll have to go further than that. There's no point in putting local councillors on the CHCs, as local authorities are generally run along this arrangement too.

But, ultimately, Welsh Labour seem quite happy with the arrangement as they've done little to change it, other than push for greater collaboration between varying authorities at local and regional level.

At the very least they should consider Elin Jones' suggestion now, or Sandy Mewies will only be the first Labour AM to (on record) get this treatment. If Labour handled it like this in England or Scotland they would be toast, but being Wales and seeing as the Chuckle Brothers down the M4 are rather unpopular at the moment, I doubt this is going to affect the party electorally.

I want them to get this right, because as long as the changes are reasonable I think we might see long-term benefits through the creation of "centres of excellence". But, yeah, at a fundamental level they're making a complete hash of it.

The thing is though, it's not entirely backbench AMs fault. But you better believe it's going to be their faces and names to it.