Wednesday, 18 June 2008

Not healthy enough

I’ve been spending some time reading the Assembly Government's consultation paper on the proposed Health Service reorganisation in Wales, mostly to try and understand what impact it will have locally. The One Wales agreement included a commitment to ending the internal market in the health service, and the proposed changes seek to implement that commitment. In that respect, at least, I welcome the proposed changes. It’s also good to see a government consultation document which has been written in a style which makes it digestible and comprehensible, with some of the detail available in backing papers rather than incorporated into the text.

That doesn’t necessarily mean that they are the right changes, however. During the Assembly election last year, I argued three things as a candidate, and I inevitably find myself comparing the proposals with what I, and Plaid, said at the time. Apart from anything else, I gave people a very explicit commitment that I would not say one thing before the election and another afterwards, unless I had very good reasons that I was able to explain.

I said then:
  • That agreement on the configuration of services locally was a more important priority for action that re-arranging the management deck chairs.
  • That there were too many bodies running the health service in Wales, and that a thorough review was needed to determine the right number, but that that was not my first priority. Plaid proposed a commission to study the whole question in detail rather than urgent piecemeal action.
  • That it was important to take an integrated view of services – one of the problems with the proposed reconfiguration of secondary care at the time was that it was predicated on the increased provision of primary care for which there was simply no viable plan.

Looked at through this prism, I find the proposals at this stage to be more than a little disappointing.

On the first point, we still do not have the clarity that I would like to see on what services will be provided where. Whilst in the short term, the proposed reconfiguration was halted, there are still legitimate concerns about the long term future of Withybush hospital and the services to be provided there; embarking on a reorganisation is likely to divert attention from the questions on which people locally want real, hard answers to the questions which SWAT and others have raised.

We have direct experience of ‘diverting attention’ locally, where five former bosses at Ceredigion Health Trust have claimed thet the merger which created the new Hywel Dda Trust was "rushed and chaotic". They allege that there have been delays, a lack of consultation, and failure to appoint key staff. The experience does not bode well for what looks like another round of piecemeal change.

On the second point, this proposed reorganisation will certainly reduce the numbers of health bodies, but the final number proposed looks to have been arrived at by accident rather than by design.

And on the third, whilst the proposed changes remove the unnecessary division between 'commissioners' and 'providers', they seem to be strengthening the split between secondary and primary care providers, which appears to me to be a potential new source of conflict. The original rationale for having 22 LHB’s was that they would be co-terminous with the county councils in order to ensure effective co-working. Removing that co-terminosity leaves another potential question over the way in which the county councils' social services departments relate to the health providers. (Unless this also presages a re-organisation of local government...).

Overall, therefore, I am unable to support the proposed changes, and have submitted comments accordingly in response to the consultation. Whether people agree with my view or not, I would urge people throughout the area to submit their own views to the Minister.

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