Health and social care in Wales

The final report of Parliamentary Review of Health and Social Care in Wales was published in pdf at the end of last month to a more muted response than health secretary Vaughan Gething would have hoped for. Perhaps this was because most of the report is "mam and cawl" and, where it is progressive, it retails ideas that have been circulating in respect of the English NHS for some time.

(For me, the report gets off to a bad start with the doctrinaire misstatement that the NHS was "born in Wales, based on a model developed by the Tredegar Workmen’s Medical Aid Society". In fact, the Tredegar scheme is one of a long line of insurance-based healthcare systems that go back to Bismarck's Germany and continue in France, Germany, some other western countries and Japan to this day. The unique and praiseworthy aspect of the Tredegar scheme was that it arose from within the community rather than being imposed by the government. The English NHS model was unique at the time - though it has since been followed elsewhere - in being funded from general taxation. Its principal architect, William Beveridge, had studied the German system before the Great War, when he was an advisor to Lloyd George and Churchill as they created the first British welfare state. Following a 1926 Royal Commission recommendation and other inter-war discussion documents, Beveridge decided that the insurance link should be broken.)

One cannot quarrel with the report's main recommendation that health and social care must be one seamless whole. Every expert seems to agree that this is where publicly-funded care systems must go. The difficulty is that along with responsibility for social care, especially for the care of an ageing population, go costs. Hence the paralysis of central government, both in London and Cardiff.

Another recommendation is that individual and community involvement should be strengthened. As I recall, this was the vision of the Labour-Lib Dem coalition government of the noughties, only for the Plaid-:Labour "One Wales" government to weaken the community health councils in 2010. There is no mention of CHCs in the report. On the other hand, it does imply that there might be more volunteer and part-time help to make up for staffing shortages at the local level.

In the report, there are many references to the need for training, and in keeping up-to-date with developments in medical practice. There is no detail as to where that training should take place. I see from wikipedia that there are five teaching hospitals in Wales, two each in Cardiff and Swansea, just one in North Wales and none in Mid-Wales. There has been a positive initiative to recruit and train nurses, but until Wales shakes off the shackles of the Conservative public pay cap, the Welsh NHS will continue to lose people to the likes of Debenhams and David Evans whose pay and conditions are more attractive. The pay scale of nurses in Wales is the worst in Britain.

There is no reference to general practice in the report, and of GPs only the issue of the central contract. Although the Royal College of GPs is cited in the list of consultees, it is difficult to see - apart from the breaking down of barriers between health and social care - where any of their concerns have been taken into account.

I suggest that most of the difficulties, including the recurrent winter crises, of the NHS would be cleared up by reversing the drain of GPs from Wales and by fulfilling the aspiration of optimal nurse staffing without resort to expensive agency nurses. Remuneration is a major factor, but not the only one.

The report is good as far as it goes, but like all previous such documents deals with institutions and processes, rather than people. We have had two major reorganisations in the NHS since devolution (the second one needless and costly in my opinion). Before we embark on another one, we should be sure that the people are in place to make sure that it goes smoothly.